Abstract Number: Esoc2026a1253 Early Adjunct Antithrombotic Therapy to Improve Short-Term Functional Outcomes in Patients With Acute Ischemic Stroke: A Network Meta-Analysis

Abstract Background and aims In patients with acute ischemic stroke (AIS), despite reperfusion treatment, there are occurrences of early neurological deterioration (END) within the first 96 hours. Adjuvant antithrombotic therapy has been considered as a treatment strategy to reduce the occurrence of END and improve neurological outcomes. We explore the role of Adjuvant antithrombotic therapy to improve neurological outcomes in patients with AIS in a network meta-analysis (NMA). Methods We performed a systematic search to include randomized clinical trials. Inclusion criteria: disabling AIS who received adjuvant antithrombotic within 96 hours of symptoms onset. The primary outcome measure was the proportion of patients with a modified Rankin Scale score of 0-1 at 90 days. A Bayesian network meta-analysis approach was taken to estimate the odds ratio (OR). A random-effects model was utilized to account for heterogeneity. Node-splitting was analyzed to assess inconsistency. We report the surface under the cumulative ranking curve (SUCRA) scores for antithrombotic strategies. Results Twenty-six randomized controlled trials containing 13204 participants examining eight antithrombotic medications were identified for inclusion within the final model (Figure). The NMA showed that Tirofiban has a higher likelihood of excellent short-term functional outcome (OR 1.6, 95% CrI 1.2-2, p=0.001) compared to control. The rank probabilities for antithrombotic strategies were higher than those for control in: Tirofiban (SUCRA=86.5%), Eptifibatide (SUCRA=69.2%), Argatroban (SUCRA=59.7%), Abciximab (SUCRA=56.1%), Dual antiplatelet strategy (SUCRA=52.3%), and Cilostazole (SUCRA=49.8%). Conclusions Early adjunct Tirofiban may improve short-term functional outcomes in patients with AIS. However, this is not a class effect. Mechanistic studies are required to assess its impact on END. Conflict of interest Ehsan Yaghoubi. Nothing to disclose