Abstract Details

Title Reteplase Versus Alteplase for Acute Ischemic Stroke: Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-020

Objective We aimed to investigate the role of reteplase compared to alteplase in AIS patients presenting within 4.5 h of symptom onset.

Background The demand for more effective and safer thrombolytic agents for acute ischemic stroke (AIS) has been increasingly recognized. Reteplase is a mutant form of alteplase with practical advantages. Nevertheless, the role of reteplase in patients with AIS is uncertain.

Design/Methods We searched electronic databases to identify randomised clinical trials (RCTs) comparing reteplase to alteplase in AIS patients presenting within 4.5 h. The primary outcomes were the 90-day excellent functional outcome (modified Rankin scale [mRS] of 0–1) and symptomatic intracerebral hemorrhage (sICH). Secondary outcomes included 90-day good functional outcome (mRS 0–2), early neurological improvement (ENI), and 90-day mortality. Odds ratios (ORs) with 95 % confidence intervals (CIs) were pooled using the fixed-effects model.

Results Of the 544 identified records, we included two high-quality RCTs (1588 patients). A total of 833 patients received reteplase (60 with 12 + 12 mg and 773 with 18 + 18 mg), while 755 patients received alteplase 0.9 mg/kg. Reteplase was associated with higher rates of excellent functional outcomes (OR, 1.55 [95 % CI, 1.23–1.95]), good functional outcomes (OR, 1.36 [95 % CI, 1.04–1.77]), and ENI (OR, 1.42 [95 %CI, 1.16–1.73]) compared to alteplase. Similar rates of sICH (OR, 1.25 [95 %CI, 0.64–2.47]) and mortality (OR, 1.18 [95 %CI, 0.72–1.92]) were noted. Optimal benefits were reported in patients treated with 18 + 18 mg of reteplase.

Conclusions In this meta-analysis, reteplase, particularly at the 18 + 18 mg dose, was more effective than alteplase with comparable safety profiles. These findings suggest that reteplase could be a viable alternative to alteplase for stroke thrombolysis. Multinational trials are needed to validate the generalizability of these results to a broader population.

Authors/Disclosures
Ahmed Alkhiri PRESENTER	Mr. Alkhiri has nothing to disclose.
Mohammed A. Aldriweesh, MBBS (King Saud bin Abdulaziz University for Health Sciences)	Dr. Aldriweesh has nothing to disclose.
Hassan K. Salamatullah, Sr.	Mr. Salamatullah has nothing to disclose.
Fahad A. Alturki	Mr. Alturki has nothing to disclose.
Aser F. Alamri	Mr. Alamri has nothing to disclose.
Ahmed A. Almaghrabi	Mr. Almaghrabi has nothing to disclose.
Hatoon Alshaikh	Mr. Alshaikh has nothing to disclose.
Thanh Nguyen, MD	Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
Fahad S. Al-Ajlan, MD	Dr. Al-Ajlan has nothing to disclose.
Adel Alhazzani, MD, FRCPC, FAAN (King Saud University)	Dr. Alhazzani has nothing to disclose.

��ɫ��

��ɫ��