Abstract Body: INTRODUCTION: Studies have suggested efficacy of glycoprotein IIb/IIIa antagonists such as tirofiban for patients with acute ischemic stroke (AIS). However, neurological deterioration is still common in many of the recommended antiplatelet regimens. We aimed to evaluate the efficacy and safety of tirofiban versus dual antiplatelet therapy (DAPT) or aspirin in patients with AIS.
METHODS: Following PRISMA guidelines, we searched Pubmed, Embase, Scopus and Cochrane databases for studies comparing effects of tirofiban versus DAPT or aspirin alone in patients with AIS. Main outcomes were increase in NIHSS score, Modified Rankin Scale (mRS) scores at 90 days (0 to 2), intracranial hemorrhage (ICH) and mortality. Statistics analysis was performed using Review Manager 5.4.1 software. Heterogeneity was assessed with I² statistics.
RESULTS: We included 5 RCT and 5 non-RCT studies covering 1,857 patients, of whom 926 were treated with Tirofiban. Neurological deterioration, assessed by changes in NIHSS scores from baseline across four studies, was less pronounced in the Tirofiban group (MD -0.32; 9% CI -0.83-0.19; p<0.05, I²=52%). MrS scores at 90 days (0 to 2) analysis favored DAPT/aspirin group (OR 1.56; 95% CI 1.11-2.18; p<0.05; I²=33%). Outcomes of ICH (OR 0.90; 95% CI 0.53-1.52; p=0.69; I²=0%) and mortality (OR 0.74; 95% CI 0.39-1.41; p=0.36; I²=5%) were both not statistically significant.
CONCLUSION: This systematic review and meta-analysis identified better effects on neurological deterioration in Tirofiban group and better mRS scores in DAPT/aspirin group, but no significant differences in other outcomes. Benefits of Tirofiban in patients with AIS are still inconclusive, requiring more studies to evaluate its efficacy and safety.