Prophylactic tirofiban versus oral dual antiplatelet therapy in patients undergoing endovascular treatment of intracranial aneurysms: A meta-analysis

BACKGROUND: Endovascular treatment of intracranial aneurysms carries the risk of perioperative thromboembolism and bleeding, and the optimal prophylactic antiplatelet strategy remains unclear. This study aimed to evaluate the efficacy and safety of prophylactic tirofiban administration compared with oral dual antiplatelet (DAP) therapy. METHODS: We searched PubMed, EMBASE, Cochrane Library, Web of Science, and Chinese National Knowledge Infrastructure databases for relevant studies up to August 2, 2023. All data analyses were conducted using RevMan 5.4 and Stata 14.0. RESULTS: Eight randomized controlled trials with a total of 806 participants receiving endovascular treatment of intracranial aneurysms were included. The results indicated that prophylactic monotherapy with tirofiban was associated with significantly higher rate of good clinical outcome (risk ratio [RR]: 1.15, 95% confidence interval [CI]: 1.03-1.28, P = .01). It also reduced the incidence of thromboembolic (RR: 0.44, 95% CI: 0.26-0.74, P = .002) and hemorrhagic (RR: 0.47, 95% CI: 0.24-0.91, P = .03) events. Subgroup analyses further revealed the benefits of prophylactic tirofiban in combination with DAP therapy in reducing the incidence of hemorrhagic events, with a trend of reducing thromboembolic events. Meanwhile, prophylactic monotherapy with tirofiban reduced the incidence of thromboembolic events without increasing the incidence of hemorrhagic events. Sensitivity analyses demonstrated the robustness of all pooled results, but it was not possible to remove the negative impact of publication bias on the pooled results. CONCLUSION: These findings support the prophylactic administration of tirofiban to patients undergoing endovascular treatment of intracranial aneurysms, as it was associated with a significantly lower incidence of thromboembolic events without increasing the risk of hemorrhagic events. More studies are needed to determine differences between prophylactic monotherapy with tirofiban and prophylactic tirofiban in combination with DAP therapy.