Tirofiban for acute ischemic stroke: systematic review and meta-analysis

Gong, Jinhong; Shang, Jingjing; Yu, Hai; Wan, Qian; Su, Dan; Sun, Zhiqiang; Liu, Guangjun

doi:10.1007/s00228-019-02817-8

Cited by 35 publications

(23 citation statements)

References 32 publications

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“…The optimal antithrombotic approach during AIS is still uncertain. Patients with the administration of tirofiban showed no improvement in functional outcome as measured by mRS at 3 months, which was in agreement with the previous studies evaluating the efficacy and safety of tirofiban monotherapy in non-selected AIS population [ 11 – 13 , 22 ]. In AIS patients receiving EVT, studies have also demonstrated that the use of tirofiban could not increase the proportion of patients with mRS 0–2 at 3 months [ 9 , 10 , 23 – 30 ].…”

Section: Discussionsupporting

confidence: 91%

“…Our study found that the mortality was similar between the control group and the tirofiban group after the 3 months’ follow-up. In line with our results, one recent meta-analysis demonstrated that the mortality at 3 months did not increase after the administration of tirofiban (OR, 0.80; 95% CI; 0.64–1.02; p = 0.07) [ 22 ]. Wu et.al performed a multicenter retrospective cohort study including 187 Chinese patients found that tirofiban use was associated with an insignificant but lower mortality at 3 months after IV thrombolysis (OR, 0.77; 95% CI, 0.19–2.27; P = 0.875) [ 32 ].…”

Section: Discussionsupporting

confidence: 91%

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Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke

et al. 2021

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Background Studies have suggested that glycoprotein IIb/IIIa antagonists such as tirofiban are beneficial for patients with acute coronary syndromes. However, it is still uncertain about the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS). Methods In this prospective non-randomized study, 255 AIS patients were recruited from 4 comprehensive stroke centers in China between January, 2017 and May, 2018. Among them,169 patients were treated with aspirin plus clopidogrel and 86 patients were treated with tirofiban. The primary functional outcome was the distribution of the 90 days’ modified Rankin Scale (mRS). The safety outcomes included the incidence of intracranial hemorrhage (ICH) at discharge and mortality at 3 months. Results In the propensity score matched cohort, tirofiban alone was noninferior to the dual antiplatelet with regard to the primary outcome (adjusted common odds ratio, 0.97; 95% confidence interval, 0.46 to 2.04; P = 0.93). Mortality at 90 days was 10% in the dual antiplatelet group and 8% in the tirofiban group (adjusted odds ratio 0.75; 95% CI 0.08 to 7.40, p = 0.81). There was no difference of the ICH rate between two groups (adjusted odds ratio 0.44; 95% CI 0.13 to 1.48, p = 0.18). In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar differences were found for functional and safety outcomes. Conclusions Our study suggested that tirofiban use appears to be safe as monotherapy in AIS treatment compared with common dual antiplatelet therapy, however, no improvement in functional outcomes was found. Trial registration Chinese clinical trial registry, ChiCTR2000034443, 05/07/2020. Retrospectively registered.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke

et al. 2021

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“…However, no consensus has been achieved on its clinical use in stroke. Three meta-analyses showed that tiro ban seems to be safe in AIS patients, but whether tiro ban could improve the functional outcome remains elusive [11][12][13]. However, another meta-analysis showed that tiro ban had no effects on the favorable outcome, and might increase the risk of fatal intracerebral hemorrhage(ICH) and mortality [14].…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of tirofiban versus oral antiplatelet drug therapy in acute ischemic stroke patients with early neurological deterioration

Xiao

Hou

Cheng

et al. 2022

Preprint

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Purpose Early neurological deterioration (END) is common after acute ischemic stroke (AIS) and associated with poor outcome. The antithrombotic strategy for END is still a pending question without specific evidence-based recommendation. Whether traditional oral antiplatelet (AP) drug or intravenous tirofiban is more beneficial for END needs further research. Our study aimed to compare the efficacy and safety of tirofiban with oral AP drugs in patients who experienced END without thrombolysis or mechanical thrombectomy and evaluate which stratified population gained the most benefit from tirofiban. Methods A total of 222 AIS patients with END from January 2016 to June 2021 were retrospectively enrolled and divided into the oral AP group and tirofiban group. The functional outcome was assessed with the National Institute of Health Stroke Scale (NIHSS) at discharge and modified Rankin scale (mRS) at 90 days. Results Compared with the oral AP group, more patients in the tirofiban group achieved NIHSS improvement by ≥2 points at discharge (61.7% vs. 25.2%, p = 0.000) and a favorable outcome (mRS 0-2) at 90 days (60.7% vs. 42.6%, p = 0.007). No moderate or severe hemorrhage occurred, and mild hemorrhage was comparable in both groups (p = 0.199). Logistic regression demonstrated that tirofiban was associated with NIHSS improvement at discharge [adjusted odds ratio (OR) 4.930; 95% confidence interval (CI) 2.731-8.898] and 90-day favorable outcome (adjusted OR 2.242; 95% CI 1.080-4.653). Subgroup analysis showed that compared with oral AP, tirofiban improved NIHSS scores at discharge in all subgroups, and improved 90-day mRS in the subgroups of large-artery atherosclerosis (p = 0.004), age ≤75 years (p = 0.03), and NIHSS 4-7 (p = 0.001). Conclusions Based on our results, tirofiban monotherapy could be an alternative to traditional oral AP strategy for the treatment of END.

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“…Tirofiban is a reversible non-peptide platelet surface glycoprotein (GP) IIB/III receptor antagonist that is widely used in the treatment of various cardiovascular diseases, and also in the prevention of coronary heart disease (9,10). Recent studies have also suggested that tirofiban could be used to prevent reocclusion and restenosis following thrombolysis or mechanical thrombectomy and may improve clinical outcomes in these patients (11)(12)(13). However, studies describing the application of tirofiban for treating patients outside the thrombolytic therapy time window are rare.…”

Section: ' Introductionmentioning

confidence: 99%

Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window

Zhang¹,

Zheng²

2021

Clinics

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Tirofiban for acute ischemic stroke: systematic review and meta-analysis

Cited by 35 publications

References 32 publications

Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke

Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke

The efficacy and safety of tirofiban versus oral antiplatelet drug therapy in acute ischemic stroke patients with early neurological deterioration

Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window

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