N Engl J Med

Reteplase tops alteplase in acute ischemic stroke

June 26, 2024

Among patients with ischemic stroke within 4.5 hours of symptom onset, reteplase was more likely to yield an excellent functional outcome than alteplase.

In the RAISE trial, patients with ischemic stroke within 4.5 hours after symptom onset were randomly assigned in a 1:1 ratio to receive IV reteplase (18-mg bolus followed 30 minutes later by a second bolus of 18 mg; n=707) or IV alteplase (0.9 mg/kg; max. dose, 90 mg; n=705). Primary efficacy outcome was an excellent functional outcome, defined as a score of 0 or 1 on the modified Rankin scale at 90 days. Primary safety outcome was symptomatic intracranial hemorrhage within 36 hours after symptom onset.

An excellent functional outcome occurred in 79.5% of reteplase recipients vs. 70.4% of alteplase recipients (risk ratio [RR], 1.13; 95% confidence interval [CI], 1.05-1.21; P<0.001 for noninferiority and P=0.002 for superiority). The rate of symptomatic intracranial hemorrhage within 36 hours was 2.4% in the reteplase group vs. 2.0% in the alteplase group (RR, 1.21; 95% CI, 0.54-2.75). Incidence of any intracranial hemorrhage at 90 days was higher with reteplase vs. alteplase (7.7% vs. 4.9%; RR, 1.59; 95% CI, 1.00 to 2.51), as was incidence of adverse events (91.6% vs. 82.4%; RR, 1.11; 95% CI, 1.03 to 1.20).

Source:

Li S, et al. (2024, June 14). N Engl J Med. Reteplase versus Alteplase for Acute Ischemic Stroke. https://pubmed.ncbi.nlm.nih.gov/38884332/