SynthesisFrontiers in neurology
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.
Synthesis in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
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Authors and funding
7 authors.
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Abstract
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.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.