Efficacy and Safety of tirofiban in acute ischemic stroke patients with early neurological deterioration: a meta-analysis

Patients with acute ischemic stroke (AIS) who experience early neurological deterioration (END) often face significant neurological disability. Given the limited efficacy of current oral antiplatelet regimens in this period, tirofiban has emerged as a potential therapeutic candidate for investigation. However, there is a lack of meta-analyses specifically assessing this effect and safety in this patient population. A meta-analysis analyzed PubMed, EMBASE, Web of Science, and Cochrane Library up to July 2025. Included studies compared tirofiban with control treatment in adult AIS patients with END. Outcomes included 90-day favorable functional outcome (mRS ≤ 2), intracerebral hemorrhage (ICH), peripheral bleeding and mortality. Seven studies (4 RCTs, 3 cohorts; 805 patients) were included. Tirofiban significantly improved 90-day functional outcomes (OR = 2.66, 95% CI 1.88–3.75; P < 0.00001), with consistent benefits in subgroups receiving or not receiving rt-PA (OR = 2.28 and 2.89, respectively). No significant increases were observed in ICH (OR = 1.46, 95% CI 0.61–3.47; P = 0.39), peripheral bleeding (OR = 1.77, 95% CI 0.94–3.32; P = 0.08), or mortality (OR = 1.02, 95% CI 0.40–2.62; P = 0.96). Heterogeneity was low, and methodological quality was high. Our findings suggest that tirofiban may improve 90-day functional outcomes in AIS patients with END, irrespective of rt-PA use. There was no statistically significant increase in the risk of intracranial hemorrhage, peripheral bleeding, or mortality.