The Prophylactic Use of Tirofiban versus Oral Antiplatelet Medications in Stent-Assisted Coiling of Intracranial Aneurysms: A Meta-analysis

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FIG 1.
Flow diagram of the selection process for relative articles. A PRISMA–compliant search (www.prisma-statement.org) of MEDLINE, EMBASE, PubMed, the Cochrane library, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed.

Table 1:

Outcomes with tirofiban versus DAPT

Outcome	Tirofiban % (95% CI)	I²	DAPT % (95% CI)	I²	P Value
Thromboembolic complications	3.6 (1.9–5.8)	33	8.5 (4.5–13.0)	88	.04
Hemorrhagic complications	3.5 (1.8–5.6)	28	5.1 (2.6–8.5)	80	.371
Perioperative mortality related to antiplatelet medication	0.8 (0.2–1.6)	15	1.2 (0.7–2.0)	0	.412
Good clinical outcomes	89.0 (74.0–99.0)	91	92.7 (87.1–96.8)	87	.589

Table 2:

Outcomes with a bolus dose plus drip of tirofiban versus drip alone

Outcome	Bolus + Drip % (95% CI)	I²	Drip % (95% CI)	P Value
Thromboembolic complications	3.9 (1.7–6.8)	54	2.4 (0.1–7.5)	.513
Hemorrhagic complications	3.0 (1.8–4.7)	30	2.5 (0.1–7.5)	.805
Perioperative mortality related to antiplatelet medication	0.8 (0.2–1.7)	42	0.7 (0.1–4.1)	.927
Good clinical outcomes	86.3 (62.8–99.0)	94	94.7 (86.6–99.2)	.391

Table 3:

Outcomes with ASA plus clopidogrel versus ASA plus ticagrelor

Outcome	ASA + Clopidogrel % (95% CI)	I²	ASA + Ticagrelor (95% CI)	I²	P Value
Thromboembolic complications	9.2 (4.7–14.8)	88	5.4 (1.7–10.9)	0	.513
Hemorrhagic complications	5.5 (2.8–9.1)	79	2.5 (0–10.5)	65	.321
Perioperative mortality related to antiplatelet medication	1.2 (0.6–1.9)	0	2.4 (0.02–8.5)	47	.583
Good clinical outcomes	93.0 (87.0–97.2)	85	93.1 (84.3–98.5)	47	.982

Table 4:

Meta-regression analysis of follow-up time affecting heterogeneity (tirofiban versus DAPT)

Variable	Coefficient (95% CI)	Standard Error	T	P Value
Thromboembolic complications	0.005 (−0.005–0.014)	0.004	1.160	.285
Hemorrhagic complications	0.002 (−0.078–0.116)	0.004	0.460	.656
Perioperative mortality related to antiplatelet medication	0.007 (−0.03–0.017)	1.710	1.710	.131
Good clinical outcomes	–0.006 (−0.017–0.006)	0.005	−1.210	.281

Table 5:

Meta-regression analysis of follow-up time affecting heterogeneity (ASA plus clopidogrel versus ASA plus ticagrelor)

Variable	Coefficient (95% CI)	Standard Error	T	P Value
Thromboembolic complications	0.005 (−0.007–0.017)	0.005	1.106	.338
Hemorrhagic complications	0.002 (−0.010–0.014)	0.005	0.42	.69
Perioperative mortality related to antiplatelet medication	0.012 (−0.042–0.066)	0.021	0.59	.581
Good clinical outcomes	−0.006 (−0.020–0.008)	0.005	–1.22	.289