Efficacy and safety of early intravenous administration of tirofiban after thrombolysis in acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials.

Intravenous thrombolysis (IVT) is the cornerstone of reperfusion therapy for acute ischemic stroke (AIS), yet only a minority of patients achieve functional independence with vessel re-occlusion in up to one-third of cases. IVT targets fibrin but does not inhibit platelet aggregation, providing a rationale for adjunctive early platelet inhibition; so in this context tirofiban, a short-acting glycoprotein IIb/IIIa antagonist, may synergize with thrombolysis, favoring better outcome for AIS patients. We conducted a systematic review and meta-analysis up to August 2025 on MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) of RCTs assessing efficacy and safety of early intravenous infusion of tirofiban after thrombolysis in AIS. Outcomes presented as forest plot included functional independence (mRS 0-2), excellent outcome (mRS 0-1), mortality, symptomatic intracranial hemorrhage (sICH), any ICH and early neurological deterioration (END). Risk of Bias was evaluated through Cochrane RoB 2.0 tool. Five RCTs (1,428 patients) were included. At 90 days, functional independence occurred in 78.7% tirofiban-treated versus in 67.8% control patients (RR 1.22, 95% CI 1.05-1.40), with a lower number of END in tirofiban group (RR 0.35, 95% CI 0.15-0.82). Excellent outcome did not significantly differ (RR 2.72, 95% CI 0.26-27.97), as well as mortality (RR 1.07, 95% CI 0.55-2.09), overall ICH rate (RR 1.14, 95% CI 0.75-1.72) and sICH (RR 1.74, 95% CI 0.41-7.42), although an increased number of sICH was observed in tirofiban group. Tirofiban after thrombolysis may be associated with higher rates of functional independence and reduced END. However, given the very low certainty of evidence due to substantial heterogeneity, and imprecision, this meta-analysis should be interpreted as hypothesis-generating, and larger RCTs are required to confirm these findings. PROSPERO: number 1230163.