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Tirofiban for acute ischemic stroke: systematic review and meta-analysis

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Abstract

Background

The safety and efficacy of tirofiban for patients with acute ischemic stroke (AIS) remains controversial. We therefore conducted a systematic review and meta-analysis.

Methods

We searched PubMed, EMBASE, Cochrane Library, Web of Science, and related international clinical trials registries through March 31, 2019, using the terms “tirofiban” and “stroke”. All apparently unconfounded randomized controlled trials (RCTs) and cohort studies with two arms comparing treatment with and without tirofiban for AIS were included in this review. Primary outcomes included symptomatic intracranial hemorrhage (sICH), fatal ICH, mortality, and modified Rankin Scale (mRS 0–2) at 3 months.

Results

Seventeen studies including 2914 AIS patients were identified. Pooled results showed that tirofiban treatment in AIS did not increase the risk of sICH (OR, 0.95; 95% CI, 0.71–1.28; p = 0.75) or mortality (OR, 0.80; 95% CI; 0.64–1.02; p = 0.07). However, fatal ICH increased significantly in the tirofiban treatment group (OR, 2.84; 95% CI, 1.38–5.85; p = 0.005), and subgroup analysis showed that tirofiban via intra-arterial (IA) administration was associated with increased risk of fatal ICH (OR, 2.90; 95% CI, 1.12–7.55; p = 0.03), while intravenous (IV) administration was not (OR, 2.75; 95% CI, 0.92–8.20; p = 0.07). In addition, tirofiban showed no obvious improvement in functional outcome (mRS 0–2) (OR, 1.29; 95% CI, 0.97–1.71; p = 0.08).

Conclusion

Tirofiban seems to be safe in systemic treatment and may represent a potential choice for management of AIS. However, intra-arterial administration requires further adequately controlled studies in order to develop an appropriate protocol, similar to that in cardiology.

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Funding

This work was supported by Changzhou Science and Technology Program (Grant No.CE20195048; CJ20190034), the Science and Technology Development Foundation of Nanjing Medical University (Grant No. NMUB2018061) and Natural Science Foundation of Jiangsu Province (Grant No.BK20191157) .

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Authors and Affiliations

  1. Department of Pharmacy, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China

    Jinhong Gong, Jingjing Shang, Dan Su & Guangjun Liu

  2. Department of Pharmaceutics, College of Pharmaceutical Sciences, Soochow University, Suzhou, China

    Jinhong Gong

  3. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China

    Hai Yu

  4. Department of Pharmacy, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China

    Qian Wan

  5. Department of Radiotherapy, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China

    Zhiqiang Sun

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Contributions

J.H.G., Q.Z.S., and G.J.L. conceptualized and designed the study, and J.H.G. and J.J.S. selected studies and planned the analysis. J.H.G., J.J.S., and H.Y. contributed to the development of the selection criteria, the assessment strategy for the risk of bias, and the data extraction criteria. Z.Q.S. and Q.W. provided statistical expertise. J.H.G. drafted the manuscript, and D.S., Z.Q.S., and G.J.L. participated in critical revision of the manuscript. All authors read, provided feedback, and approved the final manuscript as submitted.

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Correspondence to Zhiqiang Sun or Guangjun Liu.

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Gong, J., Shang, J., Yu, H. et al. Tirofiban for acute ischemic stroke: systematic review and meta-analysis. Eur J Clin Pharmacol 76, 475–481 (2020). https://doi.org/10.1007/s00228-019-02817-8

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