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

Abstract Background The risk of re-occlusion and inadequate reperfusion limits the efficacy of thrombolysis within 4.5 hours for acute ischemic stroke. 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, Science Direct, Clinicaltrials.gov, and The Cochrane Library were searched for RCTs 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 mRS score, 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 Only five trials were included from the original articles retrieved from the searched databases. 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 in mortality was observed 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.