Introduction: 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.
Method: 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.
Result: 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]).
Conclusion: 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.