Deans' stroke musings: Reteplase Bests Alteplase for Early Reperfusion in Acute Ischaemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, July 5, 2024

Reteplase Bests Alteplase for Early Reperfusion in Acute Ischaemic Stroke

Can't tell if this is good enough from what's being reported in this abstract.

Reteplase Bests Alteplase for Early Reperfusion in Acute Ischaemic Stroke

By Gabrielle Mostello

Reteplase is more likely than alteplase to result in an excellent functional outcome in patients with acute ischaemic stroke(Excellent is 100% recovery, did it do that?), according to a study published in The New England Journal of Medicine.

Alteplase is currently the standard agent used in early reperfusion therapy; however, since demand has increased significantly, alternative thrombolytic agents are needed.

For the current study, Shuya Li, MD, Beijing Tiantan Hospital, Beijing, China, and colleagues randomised patients with ischaemic stroke within 4.5 hours after symptom onset 1:1 to receive a bolus of intravenous reteplase 18 mg followed 30 minutes later by a second bolus of 18 mg (n = 707) or intravenous alteplase at 0.9 mg/kg of body weight up to a maximum dose of 90 mg (n = 705).

The researchers found that 79.5% of patients who received reteplase had an excellent functional outcome(Excellent is 100% recovery, did it do that?) compared with 70.4% of those who received alteplase (risk ratio [RR] = 1.13; 95% confidence interval [CI], 1.05-1.21; P < .001 for noninferiority and P = .002 for superiority).

Within 36 hours of disease onset, the incidence of symptomatic intracranial haemorrhage was similar between the 2 groups, occurring in 2.4% of patients in the reteplase group and 2% of those in the alteplase group (RR = 1.21; 95% CI, 0.54-2.75).

At 90 days, the incidence of any intracranial haemorrhage was higher with reteplase than with alteplase (7.7% vs 4.9%; RR = 1.59; 95% CI, 1.00-2.51), as was the incidence of adverse events (91.6% vs 82.4%; RR = 1.11; 95% CI, 1.03-1.20).

The researchers acknowledged several limitations to the study, including its open-label design, enrollment limited to Chinese adults, and under-representation of women. Furthermore, patients aged ≥80 years and patients eligible for thrombectomy were excluded.

“In patients with acute ischaemic stroke who were eligible for intravenous thrombolysis within 4.5 hours after the onset of symptoms, reteplase [is] more likely to result in an excellent functional outcome than alteplase,” the researchers concluded.

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2400314

SOURCE: The New England Journal of Medicine