SYSTEMATIC REVIEW article

Front. Neurol.

Sec. Stroke

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1552658

Intravenous Tirofiban in Acute Ischemic Stroke Patients Not Receiving Reperfusion Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Provisionally accepted
Shatha AlqurashiShatha Alqurashi1Mohammed S AlqahtaniMohammed S Alqahtani2Shahad Mohammed AlbeladiShahad Mohammed Albeladi1Saleha AlmahdawiSaleha Almahdawi1Hala DanishHala Danish1Hatoon AlshaikhHatoon Alshaikh1Ahmed AlkhiriAhmed Alkhiri1Ammar AlKawiAmmar AlKawi2Fahad AlajlanFahad Alajlan2Adel AlhazzaniAdel Alhazzani2*
  • 1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
  • 2King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

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Background: Reperfusion treatments with intravenous thrombolysis and endovascular thrombectomy after acute ischemic stroke (AIS) can improve patients' outcomes significantly. Yet, a substantial portion of patients miss the opportunity to receive reperfusion treatments. In this study, we aimed to assess the role of intravenous tirofiban in this specific population.: A search was performed in Embase, Cochrane Central Register of Controlled Trials, Medline, and Web of Science databases from inception until August 2024. The random-effects model was used to calculate odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Efficacy endpoints included excellent (modified Rankin scale of 0-1) and good (modified Rankin scale of 0-2) functional outcomes at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH), any ICH, and 90-day mortality.Results: Four randomized clinical trials, including a total of 1199 patients, were included. Of these, 599 patients (50%) received tirofiban. The meta-analysis demonstrated that tirofiban was associated with significantly higher rates of both excellent (OR 1.63 [95% CI, 1.24-2.13]; I 2 = 0) and good (OR 1.65 [95% CI,; I 2 = 0) functional outcomes at 90 days. No significant differences were observed in sICH, any ICH, or 90-days mortality.Treatment with intravenous tirofiban can be beneficial without increased risk in patients with AIS who are not eligible for reperfusion treatment. Further studies are still needed to validate the generalizability of these findings.

Keywords: Stroke, Tirofiban, Systematic review, Meta-analysis, ischemic stroke

Received: 28 Dec 2024; Accepted: 23 Apr 2025.

Copyright: © 2025 Alqurashi, Alqahtani, Albeladi, Almahdawi, Danish, Alshaikh, Alkhiri, AlKawi, Alajlan and Alhazzani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Adel Alhazzani, King Faisal Specialist Hospital and Research Centre, Riyadh, 12713, Saudi Arabia

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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