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Meta-Analysis
. 2025 Jun;15(6):e70508.
doi: 10.1002/brb3.70508.

Tirofiban Combination Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abdullah Bin Kamran  1 , Ahmed Bazil Bin Khalil  2 , Ayesha Muhammad  1 , Hira Arshad  1 , Fatima Nazir  1 , Muhammad Mateen Ali  1 , M Mairaj Umar  1 , Muhammad Farhan  1 , Sudhair Alam  3 , Javed Iqbal  4
Affiliations
Meta-Analysis

Tirofiban Combination Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abdullah Bin Kamran et al. Brain Behav. 2025 Jun.

Abstract

Introduction: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality globally. Standard antiplatelet therapies, while partially effective, do not fully inhibit all pathways of platelet aggregation, leaving patients at risk of recurrent thrombotic events. Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, has shown promise as an adjunctive treatment in AIS.

Methods: A comprehensive search was conducted in PubMed, ClinicalTrials.gov, and Cochrane library from inception to July 2024, following PRISMA guidelines. Inclusion criteria comprised randomized controlled trials (RCTs) and comparative observational studies where tirofiban was used as an adjunct to standard antiplatelet therapy. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and favorable modified Rankin scale (mRS) scores at 90 days. Secondary outcomes included National Institute of Health Stroke Scale (NIHSS) scores and all-cause mortality. Data was analyzed using Review Manager v5.4.1, with random-effects models employed for all outcomes.

Results: Fifteen studies, comprising 4,457 patients, were included. Tirofiban significantly improved the likelihood of achieving favorable mRS scores (OR 1.65, 95% CI [1.29, 2.11], p = 0.0001), with moderate heterogeneity (I2 = 57%, p = 0.006). Tirofiban also significantly reduced NIHSS scores (MD -2.08, 95% CI [-2.77, -1.39], p < 0.00001). There was no significant difference in the incidence of sICH between the tirofiban and control groups.

Conclusion: Tirofiban as an adjunct to standard antiplatelet therapy in AIS patients significantly improves functional outcomes and reduces neurological impairment without increasing the risk of sICH.

Keywords: acute ischemic stroke; antiplatelet therapy; dual antiplatelet therapy; neurology,stroke; tirofiban.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart for screening.
FIGURE 2
FIGURE 2
ROB assessment for RCTs.
FIGURE 3
FIGURE 3
Forest plot for efficacy of Tirofiban in obtaining favorable mRS scores.
FIGURE 4
FIGURE 4
Forest plot for efficacy of Tirofiban in reducing NIHSS scores.
FIGURE 5
FIGURE 5
Forest plot for safety of Tirofiban in risk of developing sICH.
FIGURE 6
FIGURE 6
Forest plot for safety of Tirofiban in terms of mortality.
FIGURE 7
FIGURE 7
Forest plot for the effect size variation in sensitivity analysis.
See this image and copyright information in PMC

References

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