A systematic review including 4 RCTs studies with a total of 21 702 subjects was abstracted in DARE. Reteplase demonstrated more rapid and complete coronary patency compared with alteplase, without a significant increase in clinical adverse effects. However, the improvement in coronary patency with reteplase vs. alteplase did not result in a reduction in mortality in one trial. The equivalence trial found that reteplase was at least as effective as streptokinase in preventing deaths in AMI patients.
Comment: The quality of evidence is downgraded by limitations in review quality.