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Desmoteplase for Acute Ischemic Stroke: A Systematic Review and Metaanalysis of Randomized Controlled Trials

[ Vol. 16 , Issue. 7 ]

Author(s):

Ahmed Elmaraezy, Abdelrahman Ibrahim Abushouk, Soha Saad, Moutaz Eltoomy, Osama Mahmoud, Hossam Mahmoud Hassan, Ahmed Aboelmakarem, Ahmed Aboel Fotoh, Farah Althaher, Nguyen Tien Huy* and Kenji Hirayama   Pages 789 - 799 ( 11 )

Abstract:


Introduction: There is an unmet need to develop better treatments for acute ischemic stroke (AIS). Desmoteplase is a vampire bat saliva-derived analogue of human tissue plasminogen activator. It has higher fibrin selectivity and a longer half-life, compared to alteplase. We performed this metaanalysis to investigate the safety and efficacy of desmoteplase in AIS.

Method: A computer literature search (PubMed, EMBASE, CENTRAL, Scopus, Web of science, and clinicaltrials.gov) was carried out. Data were extracted from eligible records and analyzed using RevMan software (version 5.3 for windows). Safety and efficacy endpoints were pooled as odds ratios (ORs) for the two groups.

Result: Five randomized trials (n=821 patients) were pooled in the final analysis. The overall effect size favored desmoteplase over placebo in terms of reperfusion 4 to 24 hours posttreatment (OR 1.49, 95% CI [1.02, 2.19]). However, the pooled effect size did not favor either of the two groups in terms of good clinical outcome at 90 days (OR 1.16, 95% CI [0.86, 1.55]). Neither of the primary safety outcomes differed significantly between the two groups (symptomatic intracranial hemorrhage: OR 1.29, 95% CI [0.53, 3.16] and mortality within 90 days: OR 1.20, 95% CI [0.73, 1.97]).

Conclusion: Current evidence suggests a favorable reperfusion effect for desmoteplase within 3 to 9 hours after AIS. Further large randomized trials, using a moderate dose between 90 µg/kg and 125 µg/kg, are required to translate this successful reperfusion into better clinical and quality of life outcomes for AIS patients.

Keywords:

Desmoteplase, ischemic stroke, mortality, meta-analysis, reperfusion, tissue plasminogen activator.

Affiliation:

Faculty of Medicine, Al-Azhar University, Cairo, Faculty of Medicine, Ain Shams University, Cairo, Faculty of Medicine, Tanta University, Tanta, Genetic Engineering & Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat City, Ahmed Maher Teaching Hospital, Cairo, Faculty of Medicine, Beni Suef University, Beni Suef, Faculty of Medicine, Tanta University, Tanta, Faculty of Medicine, Benha University, Benha, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October City, Cairo, Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523

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