Alteplase is widely used in early reperfusion therapy and is currently the standard drug in Acute Ischemic stroke (AIS). However, there are new and more affordable drugs with a prolonged half-life such as Reteplase that need further research.

We systematically searched Pubmed, Embase and Cochrane databases for studies comparing the use of reteplase and ateplase for reperfusion therapy in patients with AIS that reported the outcomes of interest: mortality (1), any adverse events (2), any Intracranial Hemorrhage (ICH) (3) and Symptomatic ICH (4). Heterogeneity was examined with I² statics. Statistical analyses were performed using R (version 4.3.1).

There were no significant differences in the efficacy and safety of reteplase compared with alteplase in treating AIS. However, it was not possible to analyze excellent functional outcomes, such as a decrease of points in the Rankin scale at 30 and 90 days, and just 2 RCT had been published in the AIS context. Reteplase is a more affordable drug that could be viable in low and middle-income countries considering cost-effectiveness, but more RCTs are needed for further evaluation.