2025 American Academy of Neurology Abstract Website

Objective:

This study aimed to assess the safety and efficacy of reteplase compared with alteplase in acute ischemic stroke.

Background:

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.

Design/Methods:

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).

Results:

Out of 725 database results, 3 studies and 1.759 patients were included. In a pooled analysis, there were no significant differences in mortality (OR 1.19; CI 0.71-1.98; p=0.509; I² 0%), symptomatic ICH (OR 1.08; CI 0.63-1.87; p=0.775; I² 0%), any ICH (OR 1.29; CI 0.83-2.01; p=0.265; I² 6%) and any adverse events (OR 1.67; CI 0.83-3.38; p = 0.03; I² 71%) between these two groups.

Conclusions:

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.