Efficacy and Safety of Initiating Intravenous Glycoprotein IIb/IIIa Inhibitors Before Acute Stent Implantation in Patients with Cerebral Infarction: A Systematic Review and Meta-Analysis.

OBJECTIVE

To evaluate the safety and efficacy of initiating glycoprotein IIb/IIIa inhibitor (GPI) infusion prior to acute intracranial artery stent implantation.

METHODS

We performed a meta-analysis using RevMan software to calculate the pooled risk ratio and 95% confidence intervals (CIs) to assess efficacy and safety.

RESULTS

The systematic review and meta-analysis included 7 studies involving 1156 patients who underwent acute stent implantation. 1) Efficacy outcomes: GPI not significantly improved favorable 90-day functional outcome (P = 0.05, I2 = 0%, CI 1.14[1.00-1.30]). GPI significantly reduced perioperative stent thrombosis (P < 0.00001, I2 = 0%, CI 0.21[0.1-0.43]), the results did not indicate a significant advantage of GPI in recanalization (P = 0.53, I2 = 0%, CI 1.01[0.98-1.04]). 2) The findings showed that GPI did not result in a higher incidence of spontaneous intracerebral hemorrhage (P = 0.76, I2 = 0%, CI 0.93[0.59-1.48]), GPI not significantly improved favorable 90-day functional outcome in patients after stenting (P = 0.05, I2 = 0%, CI 1.14[1.00-1.30]). 3) Subgroup analysis: No statistically significant differences in recanalization (Thrombolysis in Cerebral Infarction ≥2b) (P = 0.9, I2 = 0%, CI 1.00[0.95-1.06]) and perioperative spontaneous intracerebral hemorrhage (P = 0.77, I2 = 5%, CI 1.50[1.01-2.22]) between the two groups, GPI was associated with a significant reduction in the incidence of perioperative stent thrombosis (P = 0.0003, I2 = 0%, CI 0.22[0.09-0.50]) and demonstrated an improvement in favorable clinical outcomes at 90 days after acute carotid stenting (P = 0.04, I2 = 1%, P= 0.001, CI 1.23[0.98-1.54]).

CONCLUSIONS

The use of intravenous GPI before acute stent implantation can reduce perioperative intravascular thrombosis but does not improve patient outcomes at 90 days. The use of intravenous GPI before carotid acute stenting may enhance 90-day outcomes and reduce perioperative stent thrombosis.