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Updated: Jun 18, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Tenecteplase Beyond the 4.5-h Window for Patients with Acute Ischemic Stroke: An Updated Meta-Analysis of Randomized
Ocílio Ribeiro Gonçalves1, Luca Scarcia2, João Gabriel Silva Portela3
1Department of Medicine, Federal University of Piauí (UFPI), Teresina, PI, Brazil. ocilio41@gmail.com.
CNS Drugs
|June 17, 2026
Summary
Tenecteplase (TNK) improves functional outcomes in acute ischemic stroke (AIS) patients treated beyond 4.5 hours. While symptomatic intracranial hemorrhage (sICH) increased, mortality did not, supporting TNK for selected AIS patients.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has a narrow 4.5-hour window.
- Tenecteplase (TNK) is being studied as an alternative for extended time windows.
Purpose of the Study:
- Evaluate the safety and efficacy of TNK in AIS patients beyond 4.5 hours.
- Compare TNK to best medical treatment (BMT) without IVT.
Main Methods:
- Systematic literature review and meta-analysis of 6 RCTs (2297 patients).
- Assessed safety (sICH, mortality, ICH, PH2) and efficacy (mRS 0-1, mRS 0-2, early neurological improvement).
- Used random-effects model for odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- TNK significantly improved excellent functional outcomes (OR 1.40), functional independence (OR 1.27), and early neurological improvement (OR 3.21).
- TNK significantly increased symptomatic intracranial hemorrhage (sICH) (OR 2.34).
- No significant differences in 90-day mortality, any ICH, or PH2.
Conclusions:
- Intravenous TNK significantly enhances functional outcomes and neurological recovery in AIS patients treated beyond 4.5 hours.
- While sICH rates rose, they remained low, and mortality was not significantly increased.
- TNK shows potential as an effective thrombolytic for carefully selected AIS patients in extended time windows.
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