Abstract 139: Safety and Efficacy of Tirofiban Use in Acute Ischemic Stroke Patients Undergoing Thrombectomy: A Meta‐Analysis

Abstract

Introduction Intravenous thrombolysis with tissue plasminogen activator (tPA) and endovascular therapy (ET) represent the cornerstone of modern stroke management. Despite advancements in these therapies, a subset of patients fails to achieve optimal recanalization (TICI 2b‐3), which is associated with poor functional outcomes and higher mortality rates. As a result, there has been growing interest in adjunctive pharmacologic interventions that could enhance the efficacy of ET. The efficacy and safety of tirofiban as an adjunct to ET have not been conclusively established, with existing studies yielding inconsistent results. Methods We conducted a systematic review and meta‐analysis to assess the efficacy and safety of tirofiban in patients undergoing thrombectomy. A comprehensive search was carried out across PubMed, Embase, and the Cochrane Library for studies published through August 2024. For each outcome, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was evaluated using the I² statistic. Statistical analyses were performed using R. Results The meta‐analysis included 21 studies evaluating the effect of tirofiban plus ET on successful recanalization (TICI 2b‐3), showing a significant benefit with an odds ratio (OR) of 1.41 (95% CI 1.21‐1.65, p < 0.01), with low heterogeneity (I² = 25%). For excellent functional recovery (mRS 0‐1), 14 studies were analyzed, demonstrating a significant improvement with an OR of 1.17 (95% CI 1.03‐1.34, p = 0.02), and moderate heterogeneity (I² = 37%). In assessing good functional recovery (mRS 0‐2), 25 studies were pooled, and showed a significant effect of tirofiban plus ET with an OR of 1.30 (95% CI 1.19‐1.44, p < 0.01), with low heterogeneity (I² = 24%). Mortality outcomes across multiple studies revealed a significant reduction in mortality (OR 0.70, 95% CI 0.59‐0.84, p < 0.01), with moderate heterogeneity (I² = 44%). Lastly, for symptomatic intracranial hemorrhage (sICH), no significant difference was observed (OR 0.88, 95% CI 0.75‐1.04, p = 0.14), and heterogeneity was low (I² = 12%). Conclusion In conclusion, the meta‐analysis demonstrates that the addition of tirofiban to Endovascular Therapy (ET) significantly improves successful recanalization and functional recovery (mRS 0‐1 and mRS 0‐2) while reducing mortality, with low to moderate heterogeneity across the included studies. However, no significant difference in the risk of symptomatic intracranial hemorrhage (sICH) was observed. These findings suggest that Tirofiban plus ET may enhance clinical outcomes in patients undergoing treatment for acute ischemic stroke.