Efficacy and safety of Tirofiban following intravenous thrombolysis: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: The risk of re-occlusion and inadequate reperfusion limits the efficacy of intravenous thrombolysis (IVT) within 4.5 h for acute ischemic stroke (AIS). Tirofiban, a glycoprotein IIb/IIIa inhibitor, has been studied as an adjunctive treatment for patients with acute coronary syndrome. This meta-analysis evaluates existing evidence on the effectiveness and safety of Tirofiban following thrombolysis in patients with acute ischemic stroke. METHODS: PubMed, ScienceDirect, and The Cochrane Library were searched for RCTs published between 2011 and 2025. All studies included acute ischemic stroke patients, aged ≥ 18 years, NIHSS > 4, who received IV thrombolysis before Tirofiban administration. Endpoints included modified Rankin scale (mRS) score, symptomatic intracranial hemorrhage (SICH), risk of systemic bleeding, and mortality. The quality of the studies was assessed using the ROB2 tool, and risk ratios were calculated and analyzed. The protocol was registered on PROSPERO (CRD420251106033). RESULTS: Five trials met the inclusion criteria. Two trials had a low risk of bias, one had some concerns, and two had a high risk of bias. Results showed a significant improvement in mRS score with IVT plus Tirofiban (RR 1.32; 95% CI 1.07–1.62; p = 0.010), while also showing an increase in SICH with IVT plus Tirofiban; however, the results were not significant (RR 1.86; 95% CI 0.18–19.24; p = 0.60). No difference was observed in mortality between the two groups (RR 1.06; 95% CI 0.56–2.04; p = 0.85). CONCLUSION: IVT plus Tirofiban significantly improves functional outcomes without increasing mortality despite the risk of SICH.