Objective:

Background:

Reteplase efficacy and safety as a thrombolytic agent is not clear in comparison to that of Alteplase, which is the standard agent used in early reperfusion therapy, but alternative thrombolytic agents are needed. Reteplase rise as a possible alternative to Alteplase in managing patients with acute ischemic stroke within the eligible window.

Design/Methods:

We systematically searched Medline, Scopus, and Cochrane Library up to August 2024. We Included RCTs comparing the efficacy and safety of Reteplase to that of Alteplase in adult patients who received thrombolytic therapy within 4.5 hours of symptoms onset and had excellent functional status before the onset of their stroke. Primary efficacy outcome was an excellent functional outcome, defined as a modified Rankin scale score of 0 or 1 within 90 days. Primary Safety outcome was assessed using the incidence of symptomatic intracranial hemorrhage within 36 hours. Other safety outcomes were the incidences of any adverse event, serious adverse event, and death within 90 days.

Results:

Out of 376 records identified, 3 studies were included in this review, comprising 1772 patients, where males constituted 69.2% (n=634). Mean age was 62.54 (10.51) in the intervention group and 62.77 (9.59) years in the control group. Reteplase showed higher excellent functional outcome (RR=0.89 95% CI= [0.84,0.94], P=<0.0001) and higher dramatic recovery at 7-30 days (RR=1.11, 95% CI=[1.04,1.18], p=0.002) in comparison to Alteplase. Symptomatic intracranial hemorrhage within 36 hours and mortality were not significantly different between the two arms (RR=1.06, 95% CI=[0.62,1.81], p=0.83), (RR=1.18, 95% CI=[0.72,192], p=0.51] respectively. However, the incidences of any adverse event or serious event within 90 days were significantly higher in the Reteplase arm (RR=1.12, 95% CI=[1.07,1.18], p=<0.00001), (RR=4.12, 95% CI=[2.79,6.07], p=<0.00001) respectively. 

Conclusions:

Reteplase seems to be more effective and less safer than Alteplase.