Efficacy and Safety of Tirofiban for the Management of Acute Ischemic Stroke: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (RCTs)

BACKGROUND: Tirofiban is a GP IIb/IIIa inhibitor, an anti-platelet drug that is used in ischemic stroke or acute coronary syndromes. The goal of this study is to assess the safety and efficacy of the drug in patients who have suffered an acute ischemic stroke. METHODS: A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to December 2025 yielded randomized controlled trials (RCTs) comparing Tirofiban and conventional management in patients with acute ischemic stroke. We assessed the risk of bias using the revised Cochrane "Risk of bias" tool for randomized trials (RoB 2.0). We analyzed the outcomes using RevMan 5.4, with risk ratio (RR) as the effect measure. RESULTS: A total of 9 RCTs with 4210 patients were included in our meta-analysis. According to our meta-analysis, the tirofiban group was associated with a statistically significant increase in the patients showing functional independence at 90 days, measured by patients with Modified Rankin Score (mRS) of 0-2 (RR 1.13; CI = 1.06-1.20) and excellent outcome (mRS score 0-1) at 90 days (RR 1.17; CI = 1.05-1.29). We found no statistically significant difference between the two groups regarding mortality (RR 0.94; CI = 0.63-1.40). The tirofiban group had an increased incidence of intracranial hemorrhage (ICH) (RR 1.25; CI = 1.06-1.47) but had a similar incidence of symptomatic ICH as compared to the control group (RR 1.48; CI = 0.98-2.24). CONCLUSION: This meta-analysis suggests that tirofiban may improve favorable functional outcomes (mRS 0-2) in acute ischemic stroke, although the certainty of evidence was moderate. While no significant increase in sICH was observed, some analyses showed a higher rate of overall intracranial hemorrhage. These findings should therefore be interpreted cautiously, and further high-quality randomized trials are needed to confirm the efficacy and safety of tirofiban before routine guideline use.