Tenecteplase versus reteplase in acute myocardial infarction: A network meta-analysis of randomized clinical trials

Background: Acute myocardial infarction (AMI) is the leading cause of death throughout the world. One of the standard approaches to treatment of AMI is fibrinolysis. The study was conducted to evaluate the clinical efficacy of tenecteplase versus reteplase through network meta-analysis for AMI. Methods: Randomized trials were comprehensively searched in PubMed, Scopus, Cochrane library, and Web of Science using appropriate strategies. Quality assessment was done for the papers. The primary and secondary end-points were mortality, TIMI grade 3 flow at 90 minutes, death or non-fatal stroke, infarction, total stroke and major bleeding. Odds ratios (OR) were computed (95% confidence intervals). Results: After screening 27325 records, eight articles were included with total patients of 49875 to the meta-analysis. Indirect comparison of tenecteplase vs. reteplase showed no significant differences in the risk of mortality (OR= 0.98, p>0.05), TIMI grade 3 flow at 90 minutes (OR= 0.77, p>0.05), death or non-fatal stroke (OR= 1.04, p>0.05), infarction (OR= 1.11, p>0.05), total stroke (OR=2.71, p>0.05), and major bleeding (OR= 0.81, p>0.05) (all p>0.05). Conclusions: Indirect comparison suggests similar efficacy and safety of tenecteplase and reteplase. Hence, the use of each one of the two medicines depends on price, facility, and accessibility of the medicine.