Meta-analysis of the efficacy and safety of tirofiban in patients with acute ischaemic stroke undergoing mechanical thrombectomy

作者全名："Liu, Chenxi; Yang, Xun; Liu, Mingsu; Wang, Jinping; Li, Guangqing"

作者地址："[Liu, Chenxi; Li, Guangqing] Chongqing Med Univ, Dept Neurol, Affiliated Hosp 1, Chongqing 400016, Peoples R China; [Yang, Xun] Hechuan Dist Peoples Hosp, Dept Neurol, Chongqing 401500, Peoples R China; [Liu, Mingsu] Fudan Univ, Dept Neurol, Zhongshan Hosp, Shanghai 200032, Peoples R China; [Wang, Jinping] Chongqing Univ Cent Hosp, Dept Neurol, Chongqing 400050, Peoples R China"

通信作者："Li, GQ (通讯作者)，Chongqing Med Univ, Dept Neurol, Affiliated Hosp 1, Chongqing 400016, Peoples R China."

来源：CLINICAL NEUROLOGY AND NEUROSURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000981725000001

JCR分区：Q2

影响因子：1.8

年份：2023

卷号：228

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：Acute ischaemic stroke; Tirofiban; Mechanical thrombectomy; Thrombus

摘要："Introduction: Mechanical thrombectomy is now widely used in acute ischaemic stroke, but its adjunctive anti -platelet aggregation regimen is controversial. This study aimed to investigate the safety and efficacy of tirofiban in patients with acute ischaemic stroke (AIS) who underwent mechanical thrombectomy.Methods: We systematically searched Pubmed, Embase, Cochrane Library, and Web of science. Randomized controlled studies and cohort studies comparing the tirofiban group and non-tirofiban group (control group) in patients with AIS who underwent mechanical thrombectomy. The primary safety outcomes were symptomatic intracranial hemorrhage (sICH), 3-month mortality, and re-occlusion rate. The primary efficacy outcomes were good functional outcome (mRS 0-2), excellent functional outcome (mRS 0-1), and successful recanalization (mTICI >= 2b).Results: We included 22 studies with a total of 6062 patients. For safety outcomes, the tirofiban group had a non -significantly higher rate of sICH (OR = 0.90, 95 % CI = 0.73-1.10, P = 0.29) and a significantly lower rate of re -occlusion (OR = 0.40, 95 % CI = 0.19-0.82, P = 0.01) and 3-month mortality (OR = 0.71, 95 % CI = 0.61-0.82, P < 0.00001) compared to the control group. In terms of efficacy outcomes, significant improvement in good functional outcomes (mRS 0-2) (OR = 1.24, 95 % CI = 1.11-1.39, P = 0.0002) and recanalization rate (OR = 1.38, 95% CI = 1.17-1.62, P = 0.0001) compared to tirofiban, but not significant improvement in excellent functional outcomes(OR = 1.14, 95 % CI = 0.93-1.39, P = 0.21). In addition, compared with cardiogenic stroke, the large atherosclerotic stroke had a higher rate of good functional outcome (OR = 1.58, 95 % CI = 1.18-2.11, P = 0.002) and a lower rate of 3-month mortality (OR = 0.58, 95 % CI = 0.39-0.85, P = 0.005). Subgroup analysis by route of administration showed a significant improvement in good functional outcome in the intravenous group (OR = 1.27, 95 % CI = 1.08-1.50, P = 0.004), while no significant difference was found between the arterial and arteriovenous groups.Conclusion: Treatment with tirofiban in patients with AIS with mechanical thrombectomy is effective in improving functional prognosis, arterial recanalization rates, and reducing 3-month mortality and re-occlusion rates, particularly in patients with large atherosclerotic stroke, without increasing the rate of symptomatic intracranial hemorrhage. Intravenous administration of tirofiban significantly improves the clinical prognosis compared to arterial administration. Tirofiban is effective and safe in patients with AIS."

基金机构：Chongqing Natural Science Foundation Project [cstc2021jcyj-msxmX0709]

基金资助正文：Chongqing Natural Science Foundation Project (cstc2021jcyj-msxmX0709).