Efficacy and safety of tirofiban combined with intravenous thrombolysis in Acute ischemic stroke: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials and observational studies.
Neurological Research · 2026-03-20 · Meta-analysis
Abstract
BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of global morbidity and mortality. Tirofiban, a glycoprotein IIb/IIIa inhibitor, may enhance intravenous thrombolysis outcomes. Updated pooled data are needed to clarify its clinical utility and safety. METHODS: This updated meta-analysis included randomized controlled trials (RCTs) and observational studies comparing IVT plus tirofiban with IVT alone in patients with AIS. Literature was searched in PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception through 15 July 2025. Primary outcome was functional independence (modified Rankin Scale [mRS] 0-2). Secondary outcomes included excellent outcome (mRS 0-1), poor outcome (mRS 3-6) at 90 days, National Institutes of Health Stroke Scale (NIHSS) scores at 24-72 hours and NIHSS scores at 5-7 days. Safety outcomes encompassed symptomatic intracranial haemorrhage (sICH), any intracranial haemorrhage (ICH), bleeding, and 90-day mortality. Data were pooled using a random-effects model in RevMan (Version 5.1.4). RESULTS: Ten studies (4 RCTs and 6 observational; total n = 1,836) were included. Tirofiban + IVT significantly improved functional independence (RR: 1.18, 95% CI: 1.06-1.30; p = 0.002) and excellent outcomes while reducing poor outcomes. NIHSS scores improved significantly at 24-72 hours (MD = -0.72, 95% CI: -1.20 to -0.25; p = 0.003), but not at 5-7 days. Other outcomes revealed non-significant results. CONCLUSIONS: Tirofiban combined with IVT in AIS may improve recovery without significantly increasing bleeding or mortality. Further high-quality RCTs are needed to refine its use.
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Tags
Antithrombotics & thrombolytics · Thrombolytics · Mortality & survival · Quality of life & function · GP IIb/IIIa inhibitors
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