ABSTRACT NUMBER: ESOC2026A200 INTRAVENOUS TIROFIBAN AS AN ADJUNCT THERAPY FOR ACUTE ISCHEMIC STROKE PATIENTS EXPERIENCING NEUROLOGICAL WORSENING: A META-ANALYSIS OF THERAPEUTIC EFFECTIVENESS AND SAFETY

Abstract Background and aims Early neurological deterioration (END) describes the worsening of neurological function after an acute ischemic stroke (AIS) despite appropriate treatment. END affects an estimated 9–40% of AIS patients and is associated with substantial long-term disability and increased risk of death. This systematic review and meta-analysis evaluated whether intravenous tirofiban can prevent or mitigate neurological decline in AIS and assessed its safety when used in this setting. Methods PubMed, Scopus, and Web of Science were searched from inception to December 2025 for studies examining the effects of intravenous tirofiban on neurological outcomes in AIS. The search strategy combined MeSH terms and keywords, including “Tirofiban,” “Stroke,” and “Neurological/Neurologic.” Continuous outcomes were synthesized using mean differences (MD), and dichotomous outcomes using odds ratios (OR), each with 95% confidence intervals (CI). A p-value <0.05 indicated statistical significance. Results Tirofiban use was associated with a significant reduction in National Institutes of Health Stroke Scale (NIHSS) scores on day 7 compared with no tirofiban (MD = –0.56; 95% CI: –0.92 to –0.19; p = 0.003). At 3 months, tirofiban also improved functional status, increasing the likelihood of excellent outcomes (mRS 0–1) with OR = 1.54 (95% CI: 1.28–1.84; p < 0.00001; I2 = 47%, p = 0.06) and good outcomes (mRS 0–2) with OR = 1.54 (95% CI: 1.29–1.85; p < 0.00001). Conclusions Among AIS patients experiencing neurological worsening, adjunctive intravenous tirofiban appears to enhance neurological recovery and functional outcomes without increasing intracerebral hemorrhage risk and may reduce mortality. Conflict of interest all authors have has nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Conclusions