Background: The efficacy of intravenous thrombolysis is time-dependent. Reteplase has been shown to be superior to alteplase in certain acute ischemic stroke (AIS) patients.
Objective: We aimed to delineate the associations of stroke onset-to-treatment time (OTT) on the therapeutic benefits and clinical risks with reteplase in comparison to alteplase.
Methods: This is a post-hoc analysis of the Reteplase versus Alteplase for Acute Ischemic Stroke trial. Patients were divided into three groups based on their onset-to-treatment times: 0-90 mins, 91-180 mins, and 181-270 mins. The primary efficacy outcome was the proportion of participants with a modified Rankin scale score (mRS) of 0–1 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage within 36 hours post thrombolytic treatment.
Results: A total of 1399 patients (99.1%) with OTT (median, 180 mins; IQR, 135 mins to 222 mins) were included. Adjusted risk ratios of primary efficacy outcome were 1.16 (95%CI, 0.70-1.91) for 0-90 mins group, 1.14 (95%CI, 0.97-1.35) for 91-180 mins group, and 1.12 (95%CI, 0.93-1.18) for 181-270 mins group. The primary safety outcome had no difference between reteplase and alteplase in the three OTT intervals.
Conclusions: Among patients with ischemic stroke within 4.5 hours after symptom onset, there was no significant difference in the efficacy profile between reteplase and alteplase for achieving excellent functional outcomes at three different OTT intervals