OBJECTIVE:Acute ischemic stroke (AIS) requires thrombolytic therapy to restore blood flow. This meta-analysis assesses the efficacy and safety of 35 mg intravenous recombinant human prourokinase (rhPro-UK).
METHODS:A systematic search was conducted in PubMed and Embase up to 27 January 2025, identifying randomized controlled trials (RCTs) comparing rhPro-UK with standard therapy. Primary outcomes included changes in the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, and Modified Rankin Scale (mRS). Secondary outcomes comprised early neurological improvement, intracranial hemorrhage, symptomatic intracranial hemorrhage (SIH), serious adverse events (SAEs), and mortality. A random-effects model was applied for meta-analysis with 95% confidence intervals.
RESULTS:Six RCTs were included. RhPro-UK significantly reduced NIHSS scores at 24 hours (MD = -0.43 [-0.85 to -0.02], p = 0.041) and 7 days (MD = -0.85 [-1.39 to -0.31], p = 0.002). No significant differences were found in mRS scores (0-1: OR = 1.045 [0.893-1.223], p = 0.586; 0-2: OR = 0.965 [0.805-1.158], p = 0.705) or Barthel Index (OR = 1.003 [0.732-1.374], p = 0.986). The rate of SIH was similar between groups (RD = 0.001 [-0.004 to 0.006], p = 0.673). No significant differences were observed in intracranial hemorrhage (OR = 0.819 [0.598-1.140], p = 0.236), SAEs (OR = 0.907 [0.713-1.153], p = 0.426), or mortality (OR = 1.168 [0.790-1.726], p = 0.437).
CONCLUSIONS:RhPro-UK improves short-term neurological outcomes without increasing hemorrhagic risk, SAEs, or mortality.