Tenecteplase vs. alteplase for acute ischemic stroke: a systematic review

Abstract

Introduction Thrombolysis for acute ischemic stroke (AIS) with alteplase is the currently approved therapy for patients who present within 4.5 h of symptom onset and meet criteria. Recently, there has been interest in the thrombolytic tenecteplase, a modified version of alteplase, due to its lower cost, ease of administration, and studies reporting better outcomes when compared to alteplase. This systematic review compares the efficacy of tenecteplase vs. alteplase with regard to three outcomes: (1) rate of symptomatic hemorrhage, (2) functional outcome at 90 days, and (3) reperfusion grade after thrombectomy to compare the efficacy of both thrombolytics in AIS Methods The search was conducted in August 2021 in PubMed, filtered for randomized controlled trials, and studies in English. The main search term was “tenecteplase for acute stroke.” Results A total of 6 randomized clinical trials including 1675 patients with AIS was included. No one’s study compared alteplase to tenecteplase with all three outcomes after acute ischemic stroke; however, by using a combination of the results, this systematic review summarizes whether tenecteplase outperforms alteplase. Conclusions The available evidence suggests that tenecteplase appears to be a better thrombolytic agent for acute ischemic stroke when compared to alteplase.

In Vitro Antithrombotic, Hematological Toxicity, and Inhibitor Studies of Protocatechuic, Isovanillic, and p-Hydroxybenzoic Acids from Maclura tricuspidata (Carr.) Bur

“…Plasmin is formed by the conversion of t-PA or u-PA and hydrolyzes fibrin clots into fibrin degradation products [ 46 ]. Streptokinase, tenecteplase, alteplase, and reteplase have been utilized in thrombolysis and clinical studies [ 47 , 48 , 49 ]. However, most inhibitors of thrombin and FXa, or thrombolytic agents, have side effects, such as hepatotoxicity, renal impairment, thrombocytopenia, osteoporosis, low specificity, decreased platelet or white cell numbers, platelet purpura, and bleeding complications [ 50 , 51 , 52 , 53 ].…”

Comparative Efficacy and Safety of Tenecteplase and Alteplase in Acute Ischemic Stroke: A Pairwise and Network Meta-analysis of Randomized Controlled Trials

“…The risk of bias in the included studies was assessed using the revised Cochrane “Risk of bias” tool for randomized controlled trials (RoB 2.0) (9). Articles were assessed across five domains: (1) bias arising from the randomization process; (2) bias due to deviations from intended interventions; (3) bias due to missing outcome data; (4) bias in the measurement of the outcome and (5) bias in the selection of the reported result. Two review authors independently assessed the risk of bias for each study.…”

“…Across all trials, the dosage of alteplase received by all control group participants was 0.9 mg/kg. (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Table 1 summarizes the characteristics of included studies.…”

Improving treatment for acute ischemic stroke—Clot busting innovation in the pipeline

“…Tenecteplase, historically approved for AMI, has enhanced specificity for fibrin, an extended half-life compared to other rtPA alternatives (~22 mins), decreased binding affinity for PAI-1 (with increased resistance), and more practically, can be administered as a single bolus ( 8 ). It has been the focus of numerous comparative studies to alteplase ( 9 ), as well as recent clinical trials [NCT04797013 {as described in Li et al ( 10 )}, NCT04071613]. However, it has yet to attain FDA approval, despite its off-label use for intravenous thrombolysis (IVT).…”