Reteplase versus alteplase for acute ischemic stroke: Meta-analysis

Area of Science:

• Neurology
• Cardiovascular Medicine
• Pharmacology

Background:

• Growing need for improved thrombolytic therapies in acute ischemic stroke (AIS).
• Reteplase, a modified alteplase, presents potential advantages for AIS treatment.
• Uncertainty surrounds the clinical role and efficacy of reteplase in AIS.

Purpose of the Study:

• To compare the efficacy and safety of reteplase versus alteplase in AIS patients.
• To evaluate functional outcomes, symptomatic intracerebral hemorrhage, and mortality rates.
• To determine optimal dosing strategies for reteplase in AIS thrombolysis.

Main Methods:

• Systematic search of randomized clinical trials (RCTs) comparing reteplase and alteplase in AIS.
• Inclusion of two high-quality RCTs involving 1588 patients.
• Meta-analysis of outcomes including excellent functional outcome (mRS 0-1), symptomatic intracerebral hemorrhage (sICH), and mortality, using a fixed-effects model.

Main Results:

• Reteplase use was associated with significantly higher rates of excellent functional outcomes (OR 1.55) and good functional outcomes (OR 1.36) compared to alteplase.
• Reteplase also showed improved early neurological improvement (ENI) (OR 1.42).
• Rates of symptomatic intracerebral hemorrhage (sICH) and 90-day mortality were comparable between reteplase and alteplase groups. The 18 + 18 mg reteplase dose yielded optimal benefits.

Conclusions:

• Reteplase, particularly the 18 + 18 mg dose, is more effective than alteplase for AIS thrombolysis.
• Reteplase offers a comparable safety profile to alteplase.
• Reteplase represents a promising alternative for AIS treatment, warranting further multinational validation.