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Safety and efficacy of tirofiban combined with endovascular therapy compared with endovascular therapy alone in acute ischemic stroke: a meta-analysis

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Abstract

Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0–2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.

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Acknowledgments

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This study was funded by the National Key R&D Program of China (2016YFC1301600), JLUSTIRT (2017TD-12), and Science and Technology Department of Jilin Province (20180623052TC) to Yi Yang.

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Author notes

  1. YS and Z-NG contributed equally to this work.

Authors and Affiliations

  1. Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China

    Yingying Sun, Zhen-Ni Guo, Xiuli Yan, Meiqi Wang, Peng Zhang, Yan Wang, Hongjing Zhu & Yi Yang

  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Haiqiang Qin

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  1. Yingying Sun
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Electronic supplementary material

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The results of a sensitivity analysis for the incidence of symptomatic intracranial hemorrhage in acute ischemic stroke patients who underwent endovascular therapy (PNG 2063 kb)

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The results of a sensitivity analysis for 3-month mortality in acute ischemic stroke patients who underwent endovascular therapy (PNG 2063 kb)

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The results of a sensitivity analysis for the incidence of favorable functional outcomes in acute ischemic stroke patients who underwent endovascular therapy (PNG 2063 kb)

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The results of a sensitivity analysis for recanalization rates in acute ischemic stroke patients who underwent endovascular therapy (PNG 2063 kb)

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A funnel plot for assessing publication bias in regards to studies reporting the incidence of symptomatic intracranial hemorrhage in acute ischemic stroke patients who underwent endovascular therapy (PNG 2018 kb)

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A funnel plot for assessing publication bias in regards to studies reporting 3-month mortality in acute ischemic stroke patients who underwent endovascular therapy (PNG 2060 kb)

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A funnel plot for assessing publication bias in regards to studies reporting the incidence of favorable functional outcomes in acute ischemic stroke patients who underwent endovascular therapy (PNG 49 kb)

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A funnel plot for assessing publication bias in regards to studies reporting recanalization rates in acute ischemic stroke patients who underwent endovascular therapy (PNG 2057 kb)

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Sun, Y., Guo, ZN., Yan, X. et al. Safety and efficacy of tirofiban combined with endovascular therapy compared with endovascular therapy alone in acute ischemic stroke: a meta-analysis. Neuroradiology 63, 17–25 (2021). https://doi.org/10.1007/s00234-020-02530-9

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