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