Meta-analysis of Randomized Controlled Trials on Intravenous Recombinant Pro-urokinase in Acute Ischemic Stroke: Efficacy and Safety Evaluation
Asmaa Alnajjar1, Asma Daoud2, Noha Hammad3, Salma Obaid1
1Faculty of Medicine, Al-Azhar University, Gaza, Palestine., 2Faculty of Medicine, Ferhat Abbas University, Setif, Algeria, 3Faculty of Medicine, Port-Said University, Port-Said, Egypt.
Objective:
To evaluate the efficacy and safety of intravenous recombinant pro-urokinase in patients with acute ischemic stroke
Background:
Recombinant human prourokinase (rhPro-UK) is a potential alternative to alteplase for acute ischemic stroke (AIS). This meta-analysis evaluates its efficacy and safety compared to alteplase.
Design/Methods:
A systematic review and meta-analysis following PRISMA guidelines included five randomized controlled trials (RCTs) with 3,774 AIS patients treated within 4.5 hours of symptom onset (rhPro-UK: n=1,883; alteplase: n=1,891). The primary !outcome was excellent functional recovery (modified Rankin Scale [mRS] 0–1 at 90 days). Secondary outcomes included good functional recovery (mRS 0–2 at 90 days), symptomatic intracranial hemorrhage (sICH), 90-day all-cause mortality, and functional independence (Barthel Index).
Results:
No significant differences were observed between rhPro-UK and alteplase in achieving mRS 0–1 at 90 days (RR 1.02, 95% CI [0.95–1.10], P=0.56) or mRS 0–2 at 90 days (RR 0.99, 95% CI [0.97–1.02], P=0.62). Rates of sICH (RR 0.75, 95% CI [0.24–2.39], P=0.63), 90-day mortality (RR 1.16, 95% CI [0.81–1.68], P=0.42), and Barthel Index scores (RR 1.00, 95% CI [0.97–1.03], P=0.95) were also comparable
Conclusions:
rhPro-UK is non-inferior to alteplase for AIS treatment within 4.5 hours. Its targeted fibrinolytic mechanism supports its potential as an alternative thrombolytic agent, but further large-scale RCTs are needed for validation.
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