AUTHOR=Li Wei , Lin Guohui , Xiao Zaixing , Zhang Yichuan , Li Bin , Zhou Yu , Chai Erqing 

TITLE=Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.851910

DOI=10.3389/fneur.2022.851910

ISSN=1664-2295

ABSTRACT=<sec><title>Introduction</title><p>The safety and efficacy of tirofiban in intravenous thrombolysis (IVT) bridging to mechanical thrombectomy in patients with acute ischemic stroke (AIS) is unknown. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban in IVT bridging to mechanical thrombectomy in acute ischemic stroke.</p></sec><sec><title>Methods</title><p>We systematically searched PubMed, EMBASE, Web of Science, and The Cochrane Library, CNKI, and Wan Fang databases for randomized controlled trials and observational studies (case-control studies and cohort studies) comparing the tirofiban and non-tirofiban groups in AIS intravenous thrombolysis bridging to mechanical thrombectomy (Published by November 20, 2021). Our primary safety endpoints were symptomatic cerebral hemorrhage (sICH), intracranial hemorrhage (ICH), postoperative re-occlusion, and 3-month mortality; the efficacy endpoints were 3-month favorable functional outcome (MRS ≤ 2) and successful recanalization rate (modified thrombolytic therapy in cerebral infarction (mTICI) 2b or 3).</p></sec><sec><title>Results</title><p>A total of 7 studies with 1,176 patients were included in this meta-analysis. A comprehensive analysis of the included literature showed that the difference between the tirofiban and non-tirofiban groups in terms of successful recanalization (OR = 1.19, 95% Cl [0.69, 2.03], <italic>p</italic> = 0.53, <italic>I</italic><sup>2</sup> = 22%) and favorable functional outcome at 3 months (OR = 1.13, 95% Cl [0.81, 1.60], <italic>p</italic> = 0.47, <italic>I</italic><sup>2</sup> = 17%) in patients with IVT bridging mechanical thrombectomy of AIS was not statistically significant. Also, the differences in the incidence of sICH (OR = 0.97, 95% Cl [0.58, 1.62], <italic>p</italic> = 0.89) and ICH (OR = 0.83, 95% Cl [0.55, 1.24], <italic>p</italic> = 0.36) between the two groups were not statistically significant. However, the use of tirofiban during IVT bridging mechanical thrombectomy reduced the rate of postoperative re-occlusion (OR = 0.36, 95% Cl [0.14, 0.91], <italic>p</italic> = 0.03) and mortality within 3 months (OR = 0.54, 95% Cl [0.33, 0.87], <italic>p</italic> = 0.01) in patients.</p></sec><sec><title>Conclusion</title><p>The use of tirofiban during IVT bridging mechanical thrombectomy for AIS does not increase the risk of sICH and ICH in patients and reduces the risk of postoperative re-occlusion and mortality in patients within 3 months. However, this result needs to be further confirmed by additional large-sample, multicenter, prospective randomized controlled trials.</p></sec><sec><title>Systematic Review Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022297441" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.crd.york.ac.uk/PROSPERO/</ext-link>, identifier: CRD42022297441.</p></sec>