Safety and efficacy of tirofiban as an adjunct to endovascular thrombectomy in large vessel occlusion stroke: A systematic review and meta-analysis with GRADE assessment

Abstract

Background We conducted a comprehensive systematic review and meta-analysis of RCTs and observational studies comparing the effectiveness and safety of tirofiban as an adjunct to endovascular thrombectomy (EVT) in patients with large vessel occlusion (LVO) ischemic stroke. Methods We performed electronic searches across Medline through PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from inception to October 2024. Statistical analysis was conducted using RevMan software (version 5.4.1). Odds ratios (OR) were used for dichotomous outcomes and mean differences (MD) for continuous outcomes under 95% confidence intervals (CI). Results A total of 30 studies (28 cohort studies and 2 RCTs) were included in the systematic review. Of these, 28 studies comprising 7,427 cases contributed data for the analysis of symptomatic intracranial hemorrhage (sICH). There was no significant difference between tirofiban and control groups even after doing subgroup analysis based on the route of tirofiban administration (OR 0.93, 95%CI = 0.78 to 1.11). The pooled data revealed no significant difference between both groups (OR 0.92, 95%CI = 0.62 to 1.35) regarding asymptomatic intracranial hemorrhage (AsICH). On doing subgroup analysis based on the route of tirofiban administration, only the tirofiban intravenous (IV)+ intraarterial (IA) group demonstrated a lower probability of having AsICH compared to the control group (OR 0.68, 95%CI= 0.49 to 0.94). Conclusion Using tirofiban as an adjunct to EVT in patients with LVO stroke is demonstrated to be safe and effective, especially when using IV+IA dosing of tirofiban, which reduced the risk of AsICH, 3-month mortality and increased the incidence of good functional outcomes presented by modified Rankin score.