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...
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2025
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| _version_ | 1864513537603272704 |
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| author | Muhammad Hassan Waseem (22392178) |
| author2 | Zain Ul Abideen (1410154) Aiman Waheed (22392181) Hafsa Arshad Azam Raja (20151441) Sanan Rasheed (22392184) Muhammad Mukhlis (22392187) Muhammad Abdullah Ali (21409807) Marium Khan (5125439) Umama Alam (21761273) Muhammad Fawad Tahir (22073279) Javed Iqbal (2121922) Ubaid Farooq (22392190) Sania Aimen (22392193) |
| author2_role | author author author author author author author author author author author author |
| author_facet | Muhammad Hassan Waseem (22392178) Zain Ul Abideen (1410154) Aiman Waheed (22392181) Hafsa Arshad Azam Raja (20151441) Sanan Rasheed (22392184) Muhammad Mukhlis (22392187) Muhammad Abdullah Ali (21409807) Marium Khan (5125439) Umama Alam (21761273) Muhammad Fawad Tahir (22073279) Javed Iqbal (2121922) Ubaid Farooq (22392190) Sania Aimen (22392193) |
| author_role | author |
| dc.creator.none.fl_str_mv | Muhammad Hassan Waseem (22392178) Zain Ul Abideen (1410154) Aiman Waheed (22392181) Hafsa Arshad Azam Raja (20151441) Sanan Rasheed (22392184) Muhammad Mukhlis (22392187) Muhammad Abdullah Ali (21409807) Marium Khan (5125439) Umama Alam (21761273) Muhammad Fawad Tahir (22073279) Javed Iqbal (2121922) Ubaid Farooq (22392190) Sania Aimen (22392193) |
| dc.date.none.fl_str_mv | 2025-03-13T09:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1002/brb3.70420 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/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/30306145 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Neurosciences alteplase ischemic stroke meta-analysis recombinant human prourokinase systematic review |
| dc.title.none.fl_str_mv | 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 |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <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> |
| eu_rights_str_mv | openAccess |
| id | Manara2_694134817aa3aa319852e8ac8df23b92 |
| identifier_str_mv | 10.1002/brb3.70420 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/30306145 |
| publishDate | 2025 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Efficacy and Safety of Recombinant Human Prourokinase in Acute Ischemic Stroke Within 4.5 h: A Systematic Review and Meta‐Analysis of Randomized Controlled TrialsMuhammad Hassan Waseem (22392178)Zain Ul Abideen (1410154)Aiman Waheed (22392181)Hafsa Arshad Azam Raja (20151441)Sanan Rasheed (22392184)Muhammad Mukhlis (22392187)Muhammad Abdullah Ali (21409807)Marium Khan (5125439)Umama Alam (21761273)Muhammad Fawad Tahir (22073279)Javed Iqbal (2121922)Ubaid Farooq (22392190)Sania Aimen (22392193)Biomedical and clinical sciencesCardiovascular medicine and haematologyNeurosciencesalteplaseischemic strokemeta-analysisrecombinant human prourokinasesystematic review<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>2025-03-13T09:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1002/brb3.70420https://figshare.com/articles/journal_contribution/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/30306145CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/303061452025-03-13T09:00:00Z |
| spellingShingle | 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 Muhammad Hassan Waseem (22392178) Biomedical and clinical sciences Cardiovascular medicine and haematology Neurosciences alteplase ischemic stroke meta-analysis recombinant human prourokinase systematic review |
| status_str | publishedVersion |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Biomedical and clinical sciences Cardiovascular medicine and haematology Neurosciences alteplase ischemic stroke meta-analysis recombinant human prourokinase systematic review |