Alteplase is the standard for intravenous thrombolysis in acute ischemic stroke, but rhPro-UK has emerged as a potential alternative. Prior analyses pooled rhPro-UK regimens despite dosing variation. Dose-specific evaluation may clarify relative benefits and risks.

We systematically searched PubMed, EMBASE, SCOPUS, and Web of Science up to September 2025 for randomized controlled trials (RCTs). A frequentist network meta-analysis was performed using the netmeta package in R with a random-effects model and DerSimonian–Laird estimator for τ². RCTs comparing rhPro-UK at different doses with alteplase 0.9 mg/kg were included. Outcomes were excellent and good functional outcomes, early neurological improvement, mortality, intracranial hemorrhage, and overall adverse events. Language refinement was assisted by ChatGPT (OpenAI, GPT-5).

The 15 mg bolus plus 20 mg infusion regimen of rhPro-UK appears to provide similar efficacy to standard-dose alteplase, with a possible trend toward improved safety. Higher doses did not demonstrate additional benefit. These findings suggest that rhPro-UK, at the 15+20 mg regimen, may be a reasonable alternative to alteplase, but evidence does not show clear superiority.