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Updated: May 3, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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Tenecteplase vs Reteplase in Patients with Acute ST-Elevation Myocardial Infarction: A Retrospective Cohort Study
Adham Mohamed1, Sara Mahmoud2, Amr M Fahmi3
1Department of Pharmacy, Saint Luke's Hospital of Kansas City, Kansas City, MO, USA.
Summary
Tenecteplase and reteplase showed similar efficacy in acute myocardial infarction, but tenecteplase had significantly lower major bleeding rates. Further randomized trials are recommended to confirm these findings on thrombolysis for STEMI patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute ST-elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
- Fibrinolytic agents like tenecteplase and reteplase are used to restore blood flow.
- Comparing the real-world efficacy and safety of these agents is crucial for clinical decision-making.
Purpose of the Study:
- To compare the efficacy and safety of tenecteplase versus reteplase in patients experiencing acute STEMI.
- To evaluate differences in failed thrombolysis, major bleeding, cardiogenic shock, re-infarction, and mortality.
Main Methods:
- A multicenter retrospective observational study.
- Inclusion of 282 patients with acute STEMI, treated with either tenecteplase (n=229) or reteplase (n=53).
- Primary outcome: failed thrombolysis. Secondary outcomes: major bleeding, cardiogenic shock, re-infarction, and mortality.
Main Results:
- Failed thrombolysis occurred in 33.2% of the tenecteplase group versus 20.8% in the reteplase group (p=0.089).
- Major bleeding events were significantly lower with tenecteplase (0.9%) compared to reteplase (5.7%) (p=0.017).
- No significant differences were observed in mortality or other secondary outcomes between the two groups.
Conclusions:
- Tenecteplase and reteplase demonstrated comparable efficacy regarding failed thrombolysis in acute STEMI.
- Tenecteplase was associated with a significantly lower incidence of major bleeding events.
- Randomized controlled trials are warranted to validate these findings and guide optimal fibrinolytic therapy selection.
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