Safety and efficacy of tirofiban in acute ischemic stroke patients not receiving endovascular treatment: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to analyze the safety and efficacy of tirofiban when used for acute ischemic stroke (AIS) patients not undergoing endovascular treatment.An electronic search was performed for English-language studies on PubMed, Scopus, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases up to 31st July 2019. All types of studies comparing tirofiban monotherapy or combined intravenous (IV) thrombolysis and tirofiban therapy with controls for AIS patients were included.Six studies were included in the review. Three evaluated tirofiban monotherapy while three compared IV thrombolysis and tirofiban therapy with controls. Meta-analysis indicates that tirofiban monotherapy does not significantly increase the incidence of intracerebral hemorrhage (ICH) (Odds Ration [OR] 1.14, 95% CI 0.72-1.82, p = 0.57; I2 = 0%), symptomatic intracerebral hemorrhage (sICH) (OR 0.52, 95% CI 0.09-3.03, p = 0.46; I2 = 0%) and mortality (OR 0.53, 95% CI 0.13-2.07, p = 0.36; I2 = 63%) in AIS patients. Similarly, our analysis indicates no significant increase in the rates of ICH (OR 0.82, 95% CI 0.33-2.07, p = 0.68; I2 = 0%), sICH (OR 0.91, 95% CI 0.16-5.16, p = 0.91; I2 = 0%) and mortality (OR 1.50, 95% CI 0.42-5.38, p= 0.54; I2 = 0%) in AIS patients treated with combined IV thrombolysis and tirofiban therapy. Meta-analysis for functional outcome was not possible.To conclude, tirofiban appears to be safe when used following IV thrombolysis or as monotherapy in AIS patients. Conclusions regarding improvement in functional improvement cannot be drawn. Further trials are needed to strengthen the evidence on this topic.