Outcomes of Time to Treatment With Reteplase for Acute Ischemic Stroke

The efficacy of intravenous thrombolysis is time-dependent. Reteplase has been shown to be superior to alteplase in certain acute ischemic stroke patients. The authors 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. This is a post hoc analysis of the RAISE (Reteplase versus Alteplase for Acute Ischemic Stroke) trial. Patients were divided into 3 groups based on their onset-to-treatment times: 0 to 90, 91 to 180, and 181 to 270 minutes. The primary efficacy outcome was the proportion of participants with a modified Rankin scale score of 0 to 1 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage within 36 hours post-thrombolytic treatment. A total of 1,399 patients (99.1%) with OTT (median 180 minutes; Q1-Q3: 135-222 minutes) were included. Adjusted risk ratios of primary efficacy outcome were 1.16 (95% CI: 0.70-1.91) for the 0 to 90 minutes group, 1.14 (95% CI: 0.97-1.35) for 91 to 180 minutes group, and 1.12 (95% CI: 0.93-1.18) for 181 to 270 minutes group. The primary safety outcome had no difference between reteplase and alteplase in the 3 OTT intervals. 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 3 different OTT intervals. (A Study of r-PA Treating Patients With Acute Ischemic Stroke [RAISE]; NCT05295173).