Frontiers in neurology · 2026
Comparison of the efficacy and safety of different thrombolytic drugs in the treatment of acute ischemic stroke within 4.5 h: a systematic review and network meta-analysis.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Yu Xinmin, Liu Jiale, Shi Chenlei, Xue Degang, Jiang Yuting, Wang Weiwei, Zhao Miaomiao
Аннотация
BACKGROUND: Although several newer thrombolytic agents for acute ischemic stroke (AIS) within 4.5 h of onset have been developed, their relative efficacy, safety, and optimal dosing remain unclear. A comprehensive comparison across all available agents is therefore needed.
METHODS: We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for English-language reports of randomized controlled trials (RCTs) published up to December 12, 2025. Eligible trials enrolled adult AIS patients treated with intravenous thrombolysis. Primary outcomes were 90-day excellent (modified Rankin Scale [mRS] score 0-1) and good (mRS 0-2) functional outcomes. Safety outcomes were symptomatic intracranial hemorrhage (sICH), and all-cause mortality. A frequentist network meta-analysis using a fixed-effect consistency model was conducted to estimate odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS: A total of 21 RCTs involving 16,837 patients were included. For achieving mRS 0-1, reteplase (18 + 18 mg) showed a statistically significant advantage over alteplase (0.9 mg/kg) (OR 1.60; 95% CI, 1.27-2.02), and non-immunogenic recombinant staphylokinase (10 mg) demonstrated a statistically significant benefit (OR 2.23; 95% CI, 1.43-3.48). Reteplase (18 + 18 mg) also improved the likelihood of mRS 0-2 compared with alteplase (OR 1.41; 95% CI, 1.08-1.84). For safety, non-immunogenic recombinant staphylokinase significantly reduced sICH risk compared with tenecteplase 0.25 mg/kg (OR 0.31; 95% CI, 0.11-0.94). No significant differences in 90-day mortality were observed among treatments.
CONCLUSION: Within the 4.5-h treatment window, reteplase (18 + 18 mg) and non-immunogenic recombinant staphylokinase (10 mg) were associated with the highest probabilities of improved functional outcomes.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251152754.
METHODS: We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for English-language reports of randomized controlled trials (RCTs) published up to December 12, 2025. Eligible trials enrolled adult AIS patients treated with intravenous thrombolysis. Primary outcomes were 90-day excellent (modified Rankin Scale [mRS] score 0-1) and good (mRS 0-2) functional outcomes. Safety outcomes were symptomatic intracranial hemorrhage (sICH), and all-cause mortality. A frequentist network meta-analysis using a fixed-effect consistency model was conducted to estimate odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS: A total of 21 RCTs involving 16,837 patients were included. For achieving mRS 0-1, reteplase (18 + 18 mg) showed a statistically significant advantage over alteplase (0.9 mg/kg) (OR 1.60; 95% CI, 1.27-2.02), and non-immunogenic recombinant staphylokinase (10 mg) demonstrated a statistically significant benefit (OR 2.23; 95% CI, 1.43-3.48). Reteplase (18 + 18 mg) also improved the likelihood of mRS 0-2 compared with alteplase (OR 1.41; 95% CI, 1.08-1.84). For safety, non-immunogenic recombinant staphylokinase significantly reduced sICH risk compared with tenecteplase 0.25 mg/kg (OR 0.31; 95% CI, 0.11-0.94). No significant differences in 90-day mortality were observed among treatments.
CONCLUSION: Within the 4.5-h treatment window, reteplase (18 + 18 mg) and non-immunogenic recombinant staphylokinase (10 mg) were associated with the highest probabilities of improved functional outcomes.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251152754.