title: Desmoteplase for Acute Ischemic Stroke: A Systematic Review and Metaanalysis of Randomized Controlled Trials.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo. Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elmaraezy
authors.affiliation: Faculty of Medicine, Ain Shams University, Cairo. Egypt.
authors.forename: Abdelrahman Ibrahim
authors.initials: AI
authors.lastname: Abushouk
authors.affiliation: Faculty of Medicine, Tanta University, Tanta. Egypt.
authors.forename: Soha
authors.initials: S
authors.lastname: Saad
authors.affiliation: Genetic Engineering & Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat City. Egypt.
authors.forename: Moutaz
authors.initials: M
authors.lastname: Eltoomy
authors.affiliation: Ahmed Maher Teaching Hospital, Cairo. Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Mahmoud
authors.affiliation: Faculty of Medicine, Beni Suef University, Beni Suef. Egypt.
authors.forename: Hossam Mahmoud
authors.initials: HM
authors.lastname: Hassan
authors.affiliation: Faculty of Medicine, Tanta University, Tanta. Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aboelmakarem
authors.affiliation: Faculty of Medicine, Benha University, Benha. Egypt.
authors.forename: Ahmed Aboel
authors.initials: AA
authors.lastname: Fotoh
authors.affiliation: Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October City, Cairo. Egypt.
authors.forename: Farah
authors.initials: F
authors.lastname: Althaher
authors.affiliation: Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City. Vietnam.
authors.forename: Nguyen Tien
authors.initials: NT
authors.lastname: Huy
authors.affiliation: 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. Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirayama
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: C069588:salivary plasminogen activator alpha 1, Desmodus rotundus; D010960:Plasminogen Activators
keywords: Desmoteplase; ischemic stroke; meta-analysis; mortality; reperfusion; tissue plasminogen activator