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Related Experiment Video

Updated: Jul 28, 2025

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Evolving Thrombolytics: from Alteplase to Tenecteplase.

Samantha E Miller1, Steven J Warach2

  • 1Department of Neurology, Dell Medical School, University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0700, Austin, TX, 78712, USA. samantha.miller3@ascension.org.

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics
|June 5, 2023
PubMed
Summary

Tenecteplase is emerging as a safe and potentially more effective alternative to alteplase for acute ischemic stroke treatment. Ongoing trials are further evaluating its efficacy, especially in large vessel occlusions.

Keywords:
Acute ischemic strokeAlteplaseEndovascular thrombectomyTenecteplaseThrombolysis

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Alteplase has been the standard thrombolytic for acute ischemic stroke since 1995.
  • Tenecteplase, a modified tissue plasminogen activator, offers workflow advantages and potential for better large vessel recanalization.
  • Growing evidence suggests tenecteplase may be as safe or safer and more effective than alteplase.

Purpose of the Study:

  • To provide an overview of completed and ongoing trials on tenecteplase for acute ischemic stroke.
  • To analyze current data supporting tenecteplase's safety and efficacy compared to alteplase.
  • To highlight areas for future research in tenecteplase treatment.

Main Methods:

  • Review of completed and ongoing randomized controlled trials.
  • Analysis of non-randomized patient registries and observational studies.
  • Synthesis of data comparing tenecteplase and alteplase in acute ischemic stroke.

Main Results:

  • Tenecteplase demonstrates comparable or superior safety and efficacy to alteplase.
  • Evidence supports tenecteplase's effectiveness in achieving large vessel recanalization.
  • Ongoing trials are investigating tenecteplase in delayed treatment windows and with thrombectomy.

Conclusions:

  • Current data supports the safe clinical use of tenecteplase for acute ischemic stroke.
  • Tenecteplase represents a promising alternative thrombolytic agent.
  • Further research, including ongoing trials, will clarify tenecteplase's role in stroke management.