Tenecteplase versus alteplase for acute ischemic stroke

Area of Science:

• Neurology
• Pharmacology
• Clinical Trials

Background:

• Acute ischemic stroke is a leading cause of disability worldwide.
• Thrombolytic therapy, such as alteplase, is a cornerstone of acute ischemic stroke treatment.
• Tenecteplase is a newer thrombolytic agent with potential advantages.

Purpose of the Study:

• To systematically review and synthesize evidence on the benefits and harms of tenecteplase versus alteplase for acute ischemic stroke.
• To evaluate treatment effects in patients with large vessel occlusion (LVO) and non-large vessel occlusion (non-LVO) stroke.
• To explore potential health inequities by examining intervention effects across different demographic subgroups and income settings.

Main Methods:

• This is a protocol for a Cochrane Review of intervention studies.
• The review will include randomized controlled trials comparing tenecteplase with alteplase.
• Data will be synthesized using meta-analysis where appropriate, with subgroup analyses planned for demographic factors and country income levels.

Main Results:

• Primary outcomes will include measures of death and disability (e.g., modified Rankin Scale).
• Secondary outcomes will include rates of symptomatic intracerebral hemorrhage and other adverse events.
• Subgroup analyses will investigate treatment effects by age, sex, ethnicity, and country income.

Conclusions:

• The findings will inform clinical decision-making regarding the optimal choice of thrombolytic therapy for acute ischemic stroke.
• This review will highlight potential disparities in treatment effectiveness and guide strategies to promote health equity in stroke care.
• Evidence synthesis will support evidence-based guidelines for acute ischemic stroke management.