Does Endovascular Thrombectomy(ET) plus tirofiban benefit stroke patients: A systematic review and meta-analysis

Haiyan Xie; Ying Chen; Wukun Ge; Xiuping Xu; Chengjiang Liu; Zhiyong Lan; Yina Yang

doi:10.1016/j.jstrokecerebrovasdis.2023.107494

Does Endovascular Thrombectomy(ET) plus tirofiban benefit stroke patients: A systematic review and meta-analysis

J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107494. doi: 10.1016/j.jstrokecerebrovasdis.2023.107494. Epub 2023 Nov 29.

Authors

Haiyan Xie¹, Ying Chen², Wukun Ge³, Xiuping Xu⁴, Chengjiang Liu⁵, Zhiyong Lan⁶, Yina Yang⁷

Affiliations

¹ Department of clinical Pharmacy, The Third Hospital of Quzhou, Quzhou, Zhejiang 324003, China.
² Hangzhou Fuyang Hospital of traditional Chinese Medicine, Zhejiang 311400, China.
³ Department of clinical Pharmacy, Ninghai First Hospital, Zhejiang 315600, China.
⁴ Department of Emergency Medicine, The Third Hospital of Quzhou, Quzhou, Zhejiang 324003, China. Electronic address: 15695701156@163.com.
⁵ Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, 246000, China.
⁶ Department of Psychiatry Department, The Third Hospital of Quzhou, Quzhou, Zhejiang 324003, China.
⁷ Department of Neurology, Ninghai First Hospital, Zhejiang 315600, China.

PMID: 38035642
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107494

Abstract

Background: Ischemic stroke is the second leading cause of death worldwide. Endovascular thrombectomy (ET) has been shown to prevent disability in a proportion of patients. The use of tirofiban in patients undergoing ET after acute stroke has resulted in improved patient function and reduced mortality to some extent. In this systematic review and meta-analysis of the current period, an overview of the most recent studies on the potential efficacy of using tirofiban to help acute stroke patients improve function and reduce mortality was provided.

Methods: In this meta-analysis, we explore the safety and efficacy of ET combined with tirofiban in patients with acute stroke. We searched the PubMed, EMBASE, Web of Science, and The Cochrane Library database from the construction of the library to the present relevant RCTs/non-RCTs. The following key words were used for finding relevant studies from the databases"tirofiban""thrombectomy"" Stroke"" balloon angioplasty""stenting".

Results: Total of 14 trials with 4366 individuals enrolled were included in the Meta-analysis including 2732(62.6) who received ET alone and 1634(37.4 %) who received tirofiban plus ET. The primary outcome of 90-day functional independence (modified Rankin scale (mRS) score≤2) was 42.2 % (1043/2473) in the ET alone group vs. 46.2 % (684/1480) in the tirofiban with ET group (risk ratio (RR), 1.10 [95 % CI, 1.02-1.18]; P=0.02),mortality at 90 days (RR, 0.86 [95 % CI, 0.76-0.98]; P = 0.02). There is no significant between-group differences were found in excellent outcome (mRS score ≤1) (RR, 1.08 [95 % CI, 0.95-1.23]; P = 0.22), symptomatic intracranial hemorrhage (RR, 1.11 [95 % CI, 0.92-1.34]; P = 0.27).

Conclusions: These findings suggest that the use of ET combined with tirofiban in patients with acute stroke is safe and has the potential to reduce mortality and improve functional independence at 90 days.

Keywords: Endovascular Thrombectomy; Meta-analysis; Modified Rankin scale; Mortality; Stroke; Symptomatic intracranial hemorrhage; Tirofiban.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Brain Ischemia*
Endovascular Procedures* / adverse effects
Endovascular Procedures* / methods
Humans
Intracranial Hemorrhages / etiology
Stroke* / diagnostic imaging
Stroke* / therapy
Thrombectomy / adverse effects
Thrombectomy / methods
Tirofiban / adverse effects
Treatment Outcome

Substances

Tirofiban