Abstract Body: Introduction: Early neurological deterioration (END) is an adverse outcome of acute ischemic stroke that affects up to one-third of patients and is linked to poorer functional outcomes. Tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor blocker, is widely used in the treatment of atherosclerotic heart disease and percutaneous coronary intervention. Herein, we sought to assess whether Tirofiban reduces the severity of outcomes and improves stroke patient recovery through a systematic review and meta-analysis.
Methods: We systematically searched Pubmed, Cochrane, Web of Science and Scopus for randomized clinical trials and observational studies. The studies compared the effects on the administration of Tirofiban or control on END in individuals with acute ischemic stroke. Risk ratio (RR) was used for binary outcomes and mean difference (MD) for continuous endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I² statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.
Results: Seven studies and 2163 patients were included. Among them, 1132 (52,34%) were allocated to receive Tirofiban and 1031 (47,66%) received a placebo. The number of male patients was higher than females, with 1401 (64,80%), while 762 (35,20%) were women. The outcomes of END (RR 0.43; 95% CI 0.21 to 0.87; P=0.018715; I²=50%), 7th day National Institutes of Health Stroke Scale (NIHSS Score) (MD -1,03; 95% CI -2.03 to -0.02; P=0.045408; I²=72%) and score of 0 to 2 on the Modified Rankin Scale (mRS) for functional independence (MD -1.05; 95% CI -1.71 to -0.39; P=0.001916; I²=95%) presented statistical significance favoring the Tirofiban group. The following outcomes showed no statistical significance: mortality (RR 0.94; 95% CI 0.57 to 1.55; P=0.810315; I²=39%) and symptomatic intracerebral hemorrhage (RR 1.27; 95% CI 0.32 to 5.04; P=0.738112; I²=47%).
Conclusion: Even though there was no significant difference between the groups in all outcomes, such as mortality and symptomatic intracerebral hemorrhage, Tirofiban induced a favorable impact on functional outcome and improved the prognosis in patients with acute ischemic stroke. This systematic review and meta-analysis suggest that Tirofiban is efficient in preventing early neurological deterioration and improving the mRS and NIHSS scores, however, new RCTs are needed to clarify our results.