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Abstract：
BACKGROUND: Endovascular therapy and intravenous thrombolysis with recombinant tissue plasminogen activator are the 2 most recommended treatments for acute ischemic stroke (AIS). Glycoprotein (GP) IIb-IIIa inhibitors are short-acting selective reversible antiplatelet agents that emerged as promising therapeutic agents for AIS about 10 years ago. Given the unclear safety profile and application coverage of GP inhibitors, we conducted this meta-analysis to explore the same.
METHODS: We used GP IIb-IIIa inhibitors, intracranial hemorrhage, and mortality as the key words on Medline, Web of Science, and the Embase databases. Randomized controlled trials, prospective literatures, and retrospective studies in English published between 1990 and 2020 were screened. The outcomes were relative risk (RR) of death and 90-day intracerebral hemorrhage (ICH). We pooled the results in 2 categories and conducted a subgroup analysis stratified by different drugs. The choice of the effects model depended on the value of I 2.
RESULTS: In all, 3700 patients from 20 studies were included. No GP IIb-IIIa inhibitors were found to have a remarkable influence on the ICH rate. The RR values of symptomatic ICH for abciximab and eptifibatide were 4.26 (1.89, 9.59) and 0.17 (0.04, 0.69), respectively. Both tirofiban and abciximab could decrease the mortality rate within 90 days. Age > 70 years, National Institutes of Health Stroke Scale > 15, and overall dose > 10 mg are risk factors for ICH events with tirofiban usage. Thrombectomy combined with tirofiban was safe for arterial reocclusion prevention.
CONCLUSIONS: In stroke-related treatment, administration of GP IIb-IIIa inhibitors could be safe, but care should be taken regarding drug species and doses. Abciximab can increase the risk of symptomatic intracranial hemorrhage. Tirofiban and eptifibatide can be considered safe in low doses. Suitable patients should be selected using strict criteria.
METHODS: We used GP IIb-IIIa inhibitors, intracranial hemorrhage, and mortality as the key words on Medline, Web of Science, and the Embase databases. Randomized controlled trials, prospective literatures, and retrospective studies in English published between 1990 and 2020 were screened. The outcomes were relative risk (RR) of death and 90-day intracerebral hemorrhage (ICH). We pooled the results in 2 categories and conducted a subgroup analysis stratified by different drugs. The choice of the effects model depended on the value of I 2.
RESULTS: In all, 3700 patients from 20 studies were included. No GP IIb-IIIa inhibitors were found to have a remarkable influence on the ICH rate. The RR values of symptomatic ICH for abciximab and eptifibatide were 4.26 (1.89, 9.59) and 0.17 (0.04, 0.69), respectively. Both tirofiban and abciximab could decrease the mortality rate within 90 days. Age > 70 years, National Institutes of Health Stroke Scale > 15, and overall dose > 10 mg are risk factors for ICH events with tirofiban usage. Thrombectomy combined with tirofiban was safe for arterial reocclusion prevention.
CONCLUSIONS: In stroke-related treatment, administration of GP IIb-IIIa inhibitors could be safe, but care should be taken regarding drug species and doses. Abciximab can increase the risk of symptomatic intracranial hemorrhage. Tirofiban and eptifibatide can be considered safe in low doses. Suitable patients should be selected using strict criteria.
摘要：
背景：血管内治疗和重组组织型纤溶酶原激活剂静脉溶栓是两种最推荐的急性缺血性卒中（AIS）治疗方法。糖蛋白（GP）IIb-IIIa抑制剂是短效的选择性可逆抗血小板药物，约10年前成为AIS的有希望的治疗剂。鉴于GP抑制剂的安全性和应用范围不明确，我们进行了这项荟萃分析来探讨同样的问题.
方法：我们使用GPIIb-IIIa抑制剂，颅内出血,和死亡率作为Medline上的关键词，WebofScience,和Embase数据库。随机对照试验,前瞻性文献，对1990年至2020年发表的英文回顾性研究进行了筛选。结果是死亡和90天脑出血（ICH）的相对风险（RR）。我们将结果分为两个类别，并按不同药物进行了亚组分析。效果模型的选择取决于I2的值。
结果：总而言之，纳入20项研究的3700名患者。没有发现GPIIb-IIIa抑制剂对ICH发生率有显著影响。阿西昔单抗和依替巴肽的症状性ICH的RR值分别为4.26(1.89,9.59)和0.17(0.04,0.69),分别。替罗非班和阿昔单抗均可降低90天内的死亡率。年龄>70岁,美国国立卫生研究院卒中量表>15和总剂量>10mg是使用替罗非班导致ICH事件的危险因素。血栓切除术联合替罗非班用于预防动脉再闭塞是安全的。
结论：在中风相关治疗中，服用GPIIb-IIIa抑制剂可能是安全的，但是应该注意药物种类和剂量。阿昔单抗可增加症状性颅内出血的风险。替罗非班和依替巴肽在低剂量下可以被认为是安全的。应使用严格的标准选择合适的患者。
方法：我们使用GPIIb-IIIa抑制剂，颅内出血,和死亡率作为Medline上的关键词，WebofScience,和Embase数据库。随机对照试验,前瞻性文献，对1990年至2020年发表的英文回顾性研究进行了筛选。结果是死亡和90天脑出血（ICH）的相对风险（RR）。我们将结果分为两个类别，并按不同药物进行了亚组分析。效果模型的选择取决于I2的值。
结果：总而言之，纳入20项研究的3700名患者。没有发现GPIIb-IIIa抑制剂对ICH发生率有显著影响。阿西昔单抗和依替巴肽的症状性ICH的RR值分别为4.26(1.89,9.59)和0.17(0.04,0.69),分别。替罗非班和阿昔单抗均可降低90天内的死亡率。年龄>70岁,美国国立卫生研究院卒中量表>15和总剂量>10mg是使用替罗非班导致ICH事件的危险因素。血栓切除术联合替罗非班用于预防动脉再闭塞是安全的。
结论：在中风相关治疗中，服用GPIIb-IIIa抑制剂可能是安全的，但是应该注意药物种类和剂量。阿昔单抗可增加症状性颅内出血的风险。替罗非班和依替巴肽在低剂量下可以被认为是安全的。应使用严格的标准选择合适的患者。
