Efficacy and safety of tirofiban in patients with acute ischemic stroke treated with endovascular thrombectomy: A frequentist and Bayesian meta-analysis

Tirofiban is an antiplatelet treatment approved for acute coronary syndrome, but it has not been rigorously evaluated for efficacy and safety in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). Electronic databases were systematically searched for studies condu...

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Published in:Vascular pharmacology 2023-12, Vol.153, p.107244-107244, Article 107244
Main Authors: Lu, Wei-Zhen, Lin, Hui-An, Hou, Sen-Kuang, Bai, Chyi-Huey, Lin, Sheng-Feng
Format: Article
Language:English
Subjects:
Acute ischemic stroke
Bayes Theorem
Brain Ischemia - diagnostic imaging
Brain Ischemia - drug therapy
Endovascular thrombectomy
Humans
Intracranial Hemorrhages - chemically induced
Ischemic Stroke - diagnostic imaging
Ischemic Stroke - drug therapy
Stroke - diagnostic imaging
Stroke - therapy
Symptomatic intracranial hemorrhage
Thrombectomy - adverse effects
Thrombectomy - methods
Tirofiban
Tirofiban - adverse effects
Treatment Outcome
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Summary:Tirofiban is an antiplatelet treatment approved for acute coronary syndrome, but it has not been rigorously evaluated for efficacy and safety in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). Electronic databases were systematically searched for studies conducted from January 1, 2015, to July 31, 2021, that evaluated tirofiban administration for patients with AIS treated with EVT in comparison with control. Risk ratios (RRs) and confidence intervals (CIs) were estimated for favorable functional outcomes (FFOs), mortality, and symptomatic intracranial hemorrhage (SICH), each 90 days after AIS. Bayesian hierarchical modeling was performed to obtain posterior RR and its 95% highest posterior density (HPD) for validation. Compared with controls, tirofiban users exhibited increased FFOs (RR, 1.18; 95% CI, 1.08–1.30), decreased mortality (RR, 0.77; 95% CI, 0.64–0.92), and no difference in SICH (RR, 0.97; 95% CI, 0.77–1.23). Tirofiban users in the postbolus infusion subgroup exhibited increased FFOs (RR, 1.20; 95% CI, 1.07–1.35), decreased mortality (RR, 0.71; 95% CI, 0.58–0.88), and no increase in SICH (RR, 0.97; 95% CI, 0.72–1.29). The bolus-only subgroup showed no differences in FFO, mortality, or SICH between the tirofiban and control groups. Consistent results were obtained for posterior density of FFO (posterior RR, 1.20; 95% HPD, 1.06–1.34), mortality (posterior RR, 0.77; 95% HPD, 0.63–0.92), and SICH (posterior RR, 0.98; 95% HPD, 0.71–1.26). For patients with AIS treated with EVT, tirofiban improved FFOs, decreased mortality, and did not increase SICH compared with controls; postbolus infusion for administering tirofiban was more favored than the bolus-only regimen. [Display omitted]
ISSN:1537-1891
1879-3649
DOI:10.1016/j.vph.2023.107244