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Tenecteplase Thrombolysis for Acute Ischemic Stroke.

Steven J Warach1, Adrienne N Dula1, Truman J Milling1

  • 1Department of Neurology, Dell Medical School, University of Texas at Austin.

Stroke
|October 13, 2020
PubMed
Summary

Tenecteplase shows promise for ischemic stroke treatment, offering superior recanalization and non-inferior outcomes compared to alteplase. Ongoing trials will further clarify its benefits and risks.

Keywords:
fibrinhalf-lifepercutaneous coronary interventiontenecteplasetissue-type plasminogen activator

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Area of Science:

  • Neurology
  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Tenecteplase is a fibrinolytic drug approved for myocardial infarction, with favorable properties over alteplase.
  • It has been investigated for ischemic stroke thrombolysis for over a decade.
  • Current research focuses on its efficacy and safety in stroke patients.

Purpose of the Study:

  • To synthesize evidence from clinical trials comparing tenecteplase with alteplase for ischemic stroke.
  • To evaluate different doses of tenecteplase and their impact on early and long-term outcomes.
  • To assess the safety profile of tenecteplase, particularly symptomatic intracranial hemorrhage.

Main Methods:

  • Systematic literature search of published stroke clinical trials.
  • Qualitative synthesis of randomized comparisons with alteplase and dose-comparison studies.
  • Meta-analyses of pooled data from 1585 randomized patients.

Main Results:

  • Meta-analyses suggest tenecteplase superiority in recanalizing large vessel occlusions.
  • Tenecteplase demonstrated non-inferiority in 3-month disability-free outcomes compared to alteplase.
  • No significant increase in symptomatic intracranial hemorrhage or mortality was observed with tenecteplase.

Conclusions:

  • Tenecteplase is a viable option for ischemic stroke thrombolysis, particularly for large vessel occlusions.
  • The 0.25 mg/kg dose is recommended for large vessel occlusions based on superior recanalization.
  • Further phase 3 trials are needed to fully define tenecteplase's role in various stroke scenarios.