Tirofiban 12.5mg/50ml solution for infusion vials

Introduction Tirofiban is a non-peptide selective glycoprotein IIb/IIIa receptor inhibitor with a short half-life. The research assesses the efficacy and safety of continuous intravenous tirofiban in patients with acute ischemic stroke (AIS) undergoing endovascular therapy (ET). Methods A systematic search of Pubmed, Embase, Web of Science, and Cochrane Library databases is conducted from inception until January 26, 2024. Eligible studies are included based on predefined selection criteria. Efficacy outcomes (favorable functional outcome and excellent functional outcome) and safety outcomes (symptomatic intracranial hemorrhage [sICH], any intracranial hemorrhage [ICH], and 90-day mortality) are calculated using odds ratios (OR) and 95% confidence intervals (CI). Results A total of 4,329 patients from 15 studies are included in the analysis. The results indicate a significant trend toward favorable functional outcomes in the tirofiban group (OR, 1.24; 95% CI, 1.09–1.42; p = 0.001). In terms of safety outcomes, tirofiban does not increase the risk of sICH (OR, 0.90; 95% CI, 0.71–1.13; p = 0.35) or any ICH (OR, 0.97; 95% CI, 0.70–1.34; p = 0.85), but it significantly decreases 90–day mortality (OR, 0.75; 95% CI, 0.64–0.88; p = 0.0006). A subgroup analysis suggests that continuous intravenous tirofiban demonstrates better efficacy (OR, 1.24; 95% CI, 1.09–1.42; p = 0.001) for patients with AIS undergoing rescue ET with even better results when used in combination with intra–arterial and intravenous administration (OR, 1.25; 95% CI, 1.07–1.451; p = 0.005). Conclusion Continuous intravenous tirofiban is effective and safe for patients with AIS undergoing rescue ET, particularly when combined with intra-arterial tirofiban. Systematic review registration PROSPERO, identifier CRD42023385695.

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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. Methods 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 1,199 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, 1.19–2.29]; I 2 = 0) functional outcomes at 90 days. No significant differences were observed in sICH, any ICH, or 90-days mortality. Conclusion 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. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024590097 , CRD42024590097.

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OBJECT: The treatment results of combination of arterial injection of tirofiban with endovascular therapy (EVT) for acute large vessel occlusion (LVO) stroke due to intracranial atherosclerotic disease (ICAD) were inconsistent. This meta-analysis aims to assess the safety and efficacy of ICAD-LVO treatment by intra-arterial injection of tirofiban combined with EVT. METHODS: Relevant studies were identified through a systematic literature search in Pubmed, EMBASE, Web of Science and Cochrane Library databases, covering articles published from January 2010 to July 2024. The efficacy outcomes assessed in the meta-analysis included favorable functional outcome and recanalization rates. Safety outcomes included mortality and symptomatic intracranial haemorrhage (sICH). RESULTS: The meta-analysis consisted of data from 11 studies, which included 1 randomised controlled trial (RCT), 5 prospective cohort studies, and 5 retrospective cohort studies, encompassing a total of 2869 patients. The findings showed that tirofiban+EVT for ICAD-LVO was associated with significant improvements in favorable functional outcomes (RR, 1.12; 95 %CI, 1.04-1.21; P=0.005) and reductions in mortality rates (RR, 0.72; 95 %CI, 0.62-0.83; P<0.0001), despite no significant differences in the incidence of sICH (RR, 0.75; 95 % CI, 0.55-1.02; P=0.07) and recanalization rates (RR, 1.02; 95 % CI, 0.99-1.05; P=0.15). Subgroup analysis showed that the application of tirofiban significantly increased favorable functional outcomes in patients with anterior circulation stroke (RR, 1.23; 95 % CI, 1.06-1.42; P=0.005), but there was no significant difference in posterior circulation stroke (RR, 1.08; 95 % CI, 0.83-1.41; P=0.55). In addition, the use of tirofiban in patients with posterior circulation stroke might reduce the incidence of sICH (RR, 0.50; 95 % CI, 0.26-0.96; P=0.04). CONCLUSION: Tirofiban combined with EVT may be an effective treatment strategy for the treatment of ICAD-LVO, but only for patients with anterior circulation and remains unclear for patients with posterior circulation.

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