Moaz Abouelmagd: Key Findings from a Large Network Meta-Analysis of IV Thrombolytics in Acute Ischemic Stroke
Moaz Abouelmagd, Team Leader at NEGIDA Corporation, shared a post on LinkedIn about recent article by Haneen Sabet, he and his colleagues co-authored, published in Journal of Thrombosis and Thrombolysis, adding:
“I am thrilled to share the publication of our network meta-analysis in the Journal of Thrombosis and Thrombolysis (2026), where we evaluated 21 RCTs including 16,643 patients to map out the true dose-response curves of IV thrombolytics: Alteplase (tPA), Tenecteplase (TNK), Reteplase, and rhPro-UK.
Key Findings :
Efficacy Reteplase (18+18 mg) and TNK (0.25 mg/kg) achieved significantly higher rates of excellent functional recovery (mRS 0–1 at 90 days) compared to standard tPA.
Lowering tPA to 0.6 mg/kg slashed the risk of symptomatic intracranial hemorrhage (sICH) by 52% without sacrificing overall 90-day mortality or functional independence.
High-dose TNK (0.4 mg/kg) not only forfeited functional superiority but emerged as the highest bleeding risk for sICH.
Historically, meta-analyses pooled all TNK doses together. Our dose-stratified analysis unmasks a critical gradient: intermediate doses (0.25 mg/kg and 0.32 mg/kg) provide the best balance of acceptable safety and modest functional gains.
While Reteplase (18+18 mg) and rhPro-UK showed strong numerical trends, it is important to note that these trials enrolled patients with lower baseline stroke severity (NIHSS scores) compared to the TNK and tPA arms. Direct head-to-head trials are still needed to fully resolve these baseline imbalances.
Check out the full paper for the complete GRADE assessment and pairwise league tables.
Congratulations to my co-authors and the team at Meta-Analysis CRO for making this comprehensive study possible!”
Title: Comparative efficacy and safety of different doses of intravenous thrombolytics in acute ischemic stroke: a GRADE-assessed network meta-analysis of randomized controlled trials
Authors: Haneen Sabet, Moaz Elsayed Abouelmagd, Abdelrahman Shata, Mohamed El-Moslemani, Diana Kadi, Dina Essam Abo-elnour, Abdallah Abbas, Ramanathan Kadirvel and Sherief Ghozy
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