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<p>Intravenous thrombolysis (IVT) improves outcomes in acute ischemic stroke (AIS), yet many patients remain disabled. Earlier studies suggested potential benefits of adjunctive tirofiban with smaller samples and pooled heterogeneous reperfusion strategies, limiting conclusions about comparison with IVT alone. With new evidence available focused specifically on IVT-treated patients, we conducted an updated meta-analysis with a larger sample comparing tirofiban plus IVT versus IVT alone. We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing tirofiban plus IVT versus IVT alone in AIS. The primary outcome was favorable functional status at 90 days (modified Rankin Scale [mRS] 0–2). Secondary outcomes included excellent recovery (mRS 0–1), moderate-to-severe disability (mRS 3–5), early neurological improvement (NIHSS change at 24&#xa0;h and 7 days), symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and all-cause mortality. Risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. Six RCTs involving 1,793 patients were included. Compared with IVT alone, tirofiban improved favorable functional status (RR 1.14; 95% CI 1.07–1.20) and excellent recovery (RR 1.19; 95% CI 1.09–1.30), while reducing moderate-to-severe disability (RR 0.57; 95% CI 0.44–0.72). NIHSS scores at 7 days favored tirofiban (MD − 2.22; 95% CI − 4.21 to − 0.23), with no difference at 24&#xa0;h. Safety analyses showed no significant differences in sICH (RR 1.70; 95% CI 0.58–4.97), any ICH (RR 1.17; 95% CI 0.75–1.81), or all-cause mortality (RR 0.98; 95% CI 0.51–1.85). This study provides focused evidence on tirofiban in IVT-treated AIS patients. Our results highlight that adjunctive tirofiban improves 90-day functional outcomes without increasing hemorrhagic or mortality risk. These findings strengthen the rationale for considering the potential role of tirofiban as an adjuvant therapy in IVT and may inform future clinical guidelines.</p> Graphical Abstract <p></p>

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Efficacy and safety of adjuvant tirofiban versus intravenous thrombolysis alone in acute ischemic stroke: an updated meta-analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年6月18日

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  • Marianna Leite,
  • Ocílio Ribeiro Gonçalves,
  • Gabriel de Almeida Monteiro,
  • Gabriel Marinheiro,
  • Antonio Mutarelli,
  • Anderson Matheus Pereira da Silva,
  • João Vitor Andrade Fernandes,
  • Katharina Pensenstadler,
  • Jagkirat Singh,
  • Wei Jun Lee,
  • Leonardo Pipek,
  • João Paulo Mota Telles

摘要

Intravenous thrombolysis (IVT) improves outcomes in acute ischemic stroke (AIS), yet many patients remain disabled. Earlier studies suggested potential benefits of adjunctive tirofiban with smaller samples and pooled heterogeneous reperfusion strategies, limiting conclusions about comparison with IVT alone. With new evidence available focused specifically on IVT-treated patients, we conducted an updated meta-analysis with a larger sample comparing tirofiban plus IVT versus IVT alone. We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing tirofiban plus IVT versus IVT alone in AIS. The primary outcome was favorable functional status at 90 days (modified Rankin Scale [mRS] 0–2). Secondary outcomes included excellent recovery (mRS 0–1), moderate-to-severe disability (mRS 3–5), early neurological improvement (NIHSS change at 24 h and 7 days), symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and all-cause mortality. Risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. Six RCTs involving 1,793 patients were included. Compared with IVT alone, tirofiban improved favorable functional status (RR 1.14; 95% CI 1.07–1.20) and excellent recovery (RR 1.19; 95% CI 1.09–1.30), while reducing moderate-to-severe disability (RR 0.57; 95% CI 0.44–0.72). NIHSS scores at 7 days favored tirofiban (MD − 2.22; 95% CI − 4.21 to − 0.23), with no difference at 24 h. Safety analyses showed no significant differences in sICH (RR 1.70; 95% CI 0.58–4.97), any ICH (RR 1.17; 95% CI 0.75–1.81), or all-cause mortality (RR 0.98; 95% CI 0.51–1.85). This study provides focused evidence on tirofiban in IVT-treated AIS patients. Our results highlight that adjunctive tirofiban improves 90-day functional outcomes without increasing hemorrhagic or mortality risk. These findings strengthen the rationale for considering the potential role of tirofiban as an adjuvant therapy in IVT and may inform future clinical guidelines.

Graphical Abstract