Efficacy and Safety of Recombinant Human Prourokinase in Acute Ischemic Stroke Within 4.5 h: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
<h3>Background</h3><p dir="ltr">Acute ischemic stroke (AIS) requires timely thrombolysis to restore perfusion and minimize neurological damage. Recombinant human prourokinase (rhPro‐UK) has emerged as a promising alternative to alteplase, with potential efficacy and safet...
محفوظ في:
| المؤلف الرئيسي: | |
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| مؤلفون آخرون: | , , , , , , , , , , , |
| منشور في: |
2025
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إضافة وسم
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| الملخص: | <h3>Background</h3><p dir="ltr">Acute ischemic stroke (AIS) requires timely thrombolysis to restore perfusion and minimize neurological damage. Recombinant human prourokinase (rhPro‐UK) has emerged as a promising alternative to alteplase, with potential efficacy and safety benefits within the critical 4.5‐h treatment window.</p><h3>Methods</h3><p dir="ltr">Electronic databases, including PubMed, ScienceDirect, and Cochrane Central, were comprehensively searched from inception until December 2024. Risk ratios (RRs) with 95% confidence intervals were pooled for the dichotomous outcomes using a random effects model in Review Manager software. The heterogeneity among the included trials was evaluated using the <i>I</i><sup><em>2</em></sup> statistics, and a sensitivity analysis was conducted to investigate the source of heterogeneity.</p><h3>Results</h3><p dir="ltr">The final statistical analysis included 1179 participants in the rhPro‐UK and 1148 in the tPA group. Excellent functional outcome (modified Rankin Scale [mRS] 0‐1) (RR = 1.04, 95% CI: [0.98, 1.10]; <i>p</i> = 0.16) and good functional outcome (mRS 0‐2) (RR = 1.00, 95% CI: [0.96, 1.05]; <i>p</i> = 0.90; <i>I</i><sup><em>2</em></sup> = 0%) were comparable between the two groups. There was also no significant difference in mortality and major neurological improvement. However, there was a trend toward a lower risk of symptomatic intracranial hemorrhage (sICH) in the rhPro‐UK group (RR = 0.53, 95% CI: [0.18, 1.59]; <i>p</i> = 0.26).</p><h3>Conclusion</h3><p dir="ltr">rhPro‐UK demonstrated comparable efficacy to alteplase in achieving functional outcomes in AIS within 4.5 h, with no significant differences in mortality or neurological improvement. Although not statistically significant, a trend toward lower sICH risk with rhPro‐UK highlights its potential safety advantage. More high‐quality randomized clinical trials are required to confirm these findings.</p><h2>Other Information</h2><p dir="ltr">Published in: Brain and Behavior<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1002/brb3.70420" target="_blank">https://dx.doi.org/10.1002/brb3.70420</a></p> |
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