Tenecteplase for thrombolysis in stroke patients: Systematic review with meta-analysis

Area of Science:

• Neurology
• Pharmacology
• Clinical Medicine

Background:

• Alteplase is an established treatment for acute ischemic stroke.
• Tenecteplase, a modified alteplase, offers potential advantages including lower cost and simpler administration via bolus injection.

Purpose of the Study:

• To compare the efficacy and safety of tenecteplase versus alteplase in adult patients with acute ischemic stroke undergoing thrombolysis.

Main Methods:

• A systematic review and meta-analysis of observational and experimental studies was conducted.
• Studies were identified through PubMed, CENTRAL, clinical trial registries, and reference checking.
• Efficacy outcomes included functional status, recanalization, and early neurological improvement (ENI). Safety outcomes included cerebral hemorrhage (ICH), symptomatic ICH, and mortality.

Main Results:

• Eight studies involving 2031 patients were analyzed.
• Tenecteplase demonstrated significantly higher rates of recanalization (ARD=0.11) and ENI (ARD=0.10).
• No significant differences were observed in functional outcomes, cerebral hemorrhage, symptomatic ICH, or mortality between the two treatments.

Conclusions:

• Tenecteplase is a viable alternative to alteplase for acute ischemic stroke thrombolysis.
• Its favorable pharmacokinetic profile and cost-effectiveness, coupled with comparable safety and improved recanalization rates, support its use.