Medical Doctor Healthcare Institution of Southern Iceland
Introduction: Stroke is a leading cause of death and disability. Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the primary treatment for acute ischemic stroke (AIS), but its efficacy is limited. Despite advancements in thrombolytic therapy, functional outcomes remain suboptimal. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, has been investigated as an adjuvant therapy to thrombolysis to enhance reperfusion and improve clinical outcomes. This systematic review and meta-analysis evaluate the potential of eptifibatide as an adjunct to thrombolysis compared to thrombolysis alone in AIS.
Methods: We searched PubMed, Embase, and Cochrane Library databases to identify relevant randomized controlled trials (RCTs). Outcomes of interest included 90-day functional independence measured by the modified Rankin Scale (mRS), mortality, and symptomatic intracranial hemorrhage (ICH). Meta-analyses were performed using random-effects models to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I².
Results: We included 988 patients from four RCT studies. Eptifibatide was administered to 566 patients (57.3%). Adjuvant therapy (eptifibatide + rt-PA) did not significantly improve mRS at 90 days compared to rt-PA alone (OR 1.12, 95% CI 0.60–2.09, p=0.72, I²=74%). Mortality rates were also similar between the two groups (OR 1.55, 95% CI 0.92–2.61, p=0.099, I²=0%). While a slight increase in ICH risk was noted with adjuvant therapy, it was not statistically significant (OR 0.38; 95% CI 0.09–1.65; p=0.196; I²=56%).
Conclusion : Our findings suggest that adding Eptifibatide to rt-PA for stroke treatment does not significantly improve patient outcomes, including functional independence (mRS), mortality, or risk of ICH. Larger, longer-term studies are needed to definitively assess the benefits and risks of combining eptifibatide with rt-PA for acute ischemic stroke treatment.
.jpg)
