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Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies

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Abstract

To review the literature for randomized control trials (RCTs) and prospective cohort studies investigating the safety and efficacy of tirofiban and eptifibatide in patients with acute ischemic stroke (AIS). PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2021. The efficacy was evaluated based on the 3-month favorable outcome [modified Rankin scale (mRS) = 0–1], functional outcome (mRS = 0–2), and the last available National Institutes of Health Stroke Scale (NIHSS) score measured in each study. Twelve studies (two RCTs and 10 prospective cohorts) and 2926 patients were included. Treatment with tirofiban or eptifibatide had no effects on the favorable outcome (RR = 1.09, 95% CI 0.89–1.35, P = 0.411), functional outcome (RR = 1.12, 95% CI 0.98–1.28, P = 0.010), and last available NIHSS (WMD = − 2.32, 95% CI − 5.14 to 0.50, P = 0.106), but might increase mortality (RR = 0.84, 95% CI 0.71–0.99, P = 0.121). The sensitivity analyses showed that the meta-analyses were robust. There was no significant publication bias. Tirofiban did not increase the risk of ICH (P = 0. 423) and sICH (P = 0. 990) but increased the risk of fatal ICH (RR = 3.59, 95% CI 1.62–7.96, P = 0.002). Thrombolysis/thrombectomy did not influence any of the outcomes. Adding tirofiban or eptifibatide to thrombolysis/thrombectomy was not significantly associated with a favorable outcome (mRS = 0–1) nor functional outcome (mRS = 0–2) in patients with AIS at 3 months, but might be associated with mortality, possibly due to fatal ICH. The NIHSS was also not significantly different between the intervention and control groups after treatments.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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  1. Xiangya School of Medicine, Central South University, Changsha, 410013, China

    Jingting Liu

  2. Department of Emergency, Fuyang People’s Hospital, Fuyang, 236000, China

    Yihong Yang & Hongbo Liu

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LJT conceived and supervised the study; YYH searched for studies; LJT analyzed the data; XX, LJT wrote the manuscript; LHB made manuscript revisions. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Hongbo Liu.

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Liu, J., Yang, Y. & Liu, H. Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies. J Thromb Thrombolysis 53, 898–910 (2022). https://doi.org/10.1007/s11239-021-02584-3

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