Comparison of Alteplase and Forteplase Efficacy in Reperfusion Therapy of Ischemic Stroke: a Retrospective Cohort Study

The aim of the study. To compare the effectiveness of thrombolytic therapy in patients with ischemic stroke with forteplase and alteplase in clinical practice.

Materials and methods. A single-center retrospective cohort study was conducted using data from the reperfusion interventions registry at the Arkhangelsk regional vascular center. The primary endpoint was patients’ functional recovery at discharge from the hospital. The incidence of type 2 intracranial hemorrhages according to the Heidelberg bleeding classification, mortality, and the duration of hospital stay were analyzed as the secondary endpoints. Descriptive statistics were used. Simple and multivariate multiple linear and logistic regression models were constructed to assess the relationship of forteplase use with functional recovery and length of hospital stay.

Results. The study involved 213 patients with the mean age of 68 (60; 76) years, including 111 (52.1%) men. Forteplase was used in 91 (42.7%) patients. Modified Rankin scale scores of 0–2 were documented in 52 (57.14%) and 51 (41.8%) patients in the forteplase and alteplase groups, respectively, p = 0.019. After correction for potential confounders, no relationship was found between achieving good functional recovery and the use of forteplase: adjusted odds ratio was 1.04 [95% CI 0.54–2.01], p = 0.91. The incidence of type 2 parenchymal hemorrhages was 3.3% in the forteplase group vs 0.8% in the alteplase group, p = 0.315, and the mortality rates were 6.59% vs 11.48%, respectively, p = 0.247. The use of forteplase did not affect the length of hospital stay in a multivariate analysis: B = –0.54 [95% CI –3.74–2.66], p = 0.741.

Conclusion. Thrombolysis with forteplase is an effective and safe method of treatment in the acute period of ischemic stroke. Rates of achieving good functional recovery, incidence of intracranial hemorrhage, and length of hospital stay were comparable in groups treated with forteplase and alteplase after correction for significant confounders.

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