Prourokinase does not improve functional outcomes in mild ischaemic stroke

In the treatment of patients with mild ischaemic stroke, prourokinase is not necessarily better than standard of care in terms of improving functional outcomes, although both have a similar safety profile, according to a study.

A total of 1,446 patients (median age 65.9 years, 34.4 percent female, 97.6 percent Han Chinese) with a baseline NIHSS score of not more than 5 within 4.5 hours of stroke onset were enrolled in the study. Those who intended to undergo endovascular treatment were excluded. The patients were randomly assigned to receive prourokinase 35 mg (15-mg bolus + 20-mg infusion over 30 minutes, n=723) or standard care (antiplatelet or anticoagulant therapy, n=723).

The primary outcome was modified Rankin Scale score of 0 or 1 at day 90. Safety outcomes including symptomatic intracranial haemorrhage and death were also assessed.

At day 90, the percentage of patients who achieved the primary outcome was 88.5 percent in the prourokinase group and 91.0 percent in the standard care group (relative risk, 0.97, 95 percent confidence interval [CI], 0.94–1.01; p=0.12).

Likewise, results for safety outcomes showed no significant between-group differences. Symptomatic intracranial haemorrhage occurred in 0.7 percent of patients with prourokinase and in 0 percent with standard care. Mortality at 90 days was 2.3 percent and 1.4 percent, respectively.