Tirofiban after intravenous thrombolysis in acute ischemic stroke patients: An updated systematic review and meta-analysis of randomized controlled trials

Early antiplatelet therapy after intravenous thrombolysis (IVT) for acute ischemic stroke remains controversial because of concerns regarding hemorrhagic complications. Tirofiban, a reversible glycoprotein IIb/IIIa receptor antagonist, may reduce platelet-mediated rethrombosis and improve reperfusion after thrombolysis. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of early intravenous tirofiban following IVT. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception through May 2026. RCTs comparing early intravenous tirofiban versus standard care or placebo after IVT were included. Outcomes included functional independence (modified Rankin Scale [mRS] 0–2), excellent outcome (mRS 0–1), symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and 90-day mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Six randomized controlled trials (RCTs) involving 1787 patients were included. Tirofiban significantly increased the likelihood of achieving functional independence at 90 days (RR, 1.14; 95% CI, 1.03–1.25; P = 0.019). Although tirofiban showed a trend toward improving excellent functional outcome, the difference was not statistically significant (RR, 1.21; 95% CI, 0.95–1.56; P = 0.080). No significant differences were observed in symptomatic intracranial hemorrhage (RR, 1.72; 95% CI, 0.57–5.19; P = 0.265), any intracranial hemorrhage (RR, 1.17; 95% CI, 0.72–1.90; P = 0.453), or 90-day mortality (RR, 0.92; 95% CI, 0.59–1.45; P = 0.668). Sensitivity analyses demonstrated robust findings across all outcomes. Early intravenous tirofiban following thrombolysis was associated with improved functional recovery without a significant increase in mortality or intracranial hemorrhage on a relative scale. Although a 1% absolute increase in symptomatic ICH was observed, the difference was not statistically significant. These findings support further investigation of tirofiban as an adjunct to thrombolysis in selected patients with acute ischemic stroke.