Meta-analysis shows tirofiban improves functional independence but raises intracranial hemorrhage risk in acute ischemic stroke patients
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Key Takeaway
Tirofiban improves functional independence but increases intracranial hemorrhage risk in acute ischemic stroke patients; further trials needed.
This meta-analysis evaluated the impact of tirofiban versus conventional management in patients suffering from acute ischemic stroke. The study included 4,210 participants and assessed outcomes over a 90-day follow-up period to determine efficacy and safety profiles.
results indicated a statistically significant increase in functional independence at 90 days for the tirofiban group. The relative risk was 1.13 with a confidence interval of 1.06 to 1.20. Additionally, excellent outcomes at 90 days also showed a significant improvement with a relative risk of 1.17.
Safety concerns emerged regarding bleeding risks. The incidence of intracranial hemorrhage increased in the tirofiban group with a relative risk of 1.25. Mortality rates showed no statistically significant difference between the two treatment groups. Symptomatic intracranial hemorrhage incidence remained similar between groups, though the confidence interval approached statistical significance.
The certainty of the evidence was rated as moderate. Consequently, findings should be interpreted cautiously. Further high-quality randomized trials are needed to confirm both efficacy and safety. Routine guideline use requires confirmation before widespread adoption of this intervention.
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View Original Abstract ↓
BACKGROUND: Tirofiban is a GP IIb/IIIa inhibitor, an anti-platelet drug that is used in ischemic stroke or acute coronary syndromes. The goal of this study is to assess the safety and efficacy of the drug in patients who have suffered an acute ischemic stroke.
METHODS: A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to December 2025 yielded randomized controlled trials (RCTs) comparing Tirofiban and conventional management in patients with acute ischemic stroke. We assessed the risk of bias using the revised Cochrane "Risk of bias" tool for randomized trials (RoB 2.0). We analyzed the outcomes using RevMan 5.4, with risk ratio (RR) as the effect measure.
RESULTS: A total of 9 RCTs with 4210 patients were included in our meta-analysis. According to our meta-analysis, the tirofiban group was associated with a statistically significant increase in the patients showing functional independence at 90 days, measured by patients with Modified Rankin Score (mRS) of 0-2 (RR 1.13; CI = 1.06-1.20) and excellent outcome (mRS score 0-1) at 90 days (RR 1.17; CI = 1.05-1.29). We found no statistically significant difference between the two groups regarding mortality (RR 0.94; CI = 0.63-1.40). The tirofiban group had an increased incidence of intracranial hemorrhage (ICH) (RR 1.25; CI = 1.06-1.47) but had a similar incidence of symptomatic ICH as compared to the control group (RR 1.48; CI = 0.98-2.24).
CONCLUSION: This meta-analysis suggests that tirofiban may improve favorable functional outcomes (mRS 0-2) in acute ischemic stroke, although the certainty of evidence was moderate. While no significant increase in sICH was observed, some analyses showed a higher rate of overall intracranial hemorrhage. These findings should therefore be interpreted cautiously, and further high-quality randomized trials are needed to confirm the efficacy and safety of tirofiban before routine guideline use.
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