Comparison of thrombolytic agents in treatment of patients with acute ischemic stroke; findings from a single centre follow up study in real-life settings.

George, Mathew; Baby, Neena; Paul, Reji; Zabeer, Mohammed; Thomas, Chinchu

doi:10.1016/j.jocn.2021.07.004

Cited by 10 publications

(14 citation statements)

References 26 publications

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“…Primary studies available for the analyses include RCTs ( n = 11), 8 –18 observational studies and registry based retrospective studies ( n = 7). 19,26 –31 Studies comparing treatment with TNK and rt-PA ( n = 14) 8 –12,15 –18,26,28 –31 are included in the meta-analyses, whereas these studies and the studies comparing different dosage regimens of TNK ( n = 4) 13,14,19,27 are included in the NMAs (Table S2). There are possible overlapping cases in Psychogios et al 30 and Tsivgoulis et al 31 Data on Excellent and Good functional outcomes and SICH and mortality within 90 days outcomes were taken from Tsivgoulis et al 31 and the rest of the outcome measure data were taken from Psychogios et al 30…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies 9,10,12,18,26,28 –30 are included in the meta-analysis for recanalization outcome. The current meta-analysis considered not only complete recanalization (TIMI = 3 or mTICI = 3) but also recanalization more than 50% (TIMI ⩾ 2 or mTICI ⩾ 2b ) as successful recanalization, as consistent with the definitions of the included studies (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies 8 –12,16,17,26,29,30 (2061 individuals) were included in meta-analysis. The results are significant for TNK 0.25 mg/kg subgroup (OR = 2.35 [95% CI = 1.16–4.72]) and in the overall grouped comparison comprising all TNK dosages (OR = 1.66 [95% CI = 1.11–2.50], p = 0.02) (Figure 1(b)).…”

Section: Resultsmentioning

confidence: 99%

“…For NMA, there are twelve studies 8 –12,14,16 –18,26,29,30 (4695 individuals). TNK 0.40 mg/kg was significantly associated with SICH (OR = 2.35 [95% CI = 1.19–4.64], p -value = 0.01) compared to rt-PA treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies [8][9][10][11][12]16,17,26,29,30 Additional analysis excluding the study that measured outcomes at 14 days was performed. 17 The overall group comparison was still significantly in favor of TNK treatment (OR = 1.81 [95% CI = 1.07-3.06], p-value = 0.03).…”

Section: Early Neurological Improvementmentioning

confidence: 99%

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Different dosing regimens of Tenecteplase in acute ischemic stroke: A network meta-analysis of the clinical evidence

The

Lin

Matar

et al. 2022

European Stroke Journal

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Introduction: Acute ischemic stroke remains the major cause of death and disability and conclusive evidence of Tenecteplase in treating stroke is lacking. Objective: To conduct a meta-analysis to determine whether Tenecteplase produces better outcomes than Alteplase and a network meta-analysis comparing the different dosing regimens of Tenecteplase. Methods: Searches were made in MEDLINE, CENTRAL, and ClinicalTrials.gov. The outcome measures are recanalization, early neurological improvement, functional outcomes at 90 days (modified Rankin Scale 0–1 and 0–2), intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality within 90 days from treatment. Results: Fourteen studies are included in the meta-analyses and 18 studies in the network meta-analyses. In the meta-analysis, Tenecteplase 0.25 mg/kg has significant results in early neurological improvement (OR = 2.35, and 95% CI = 1.16–4.72) and excellent functional outcome (OR = 1.20, and 95% CI = 1.02–1.42). In the network meta-analysis, Tenecteplase 0.25 mg/kg produces significant results in early neurological improvement (OR = 1.52 [95% CI = 1.13–2.05], p-value = 0.01), functional outcomes (mRS 0–1 and 0–2) (OR = 1.19 [95% CI = 1.03–1.37], p-value = 0.02; OR = 1.21 [95% CI = 1.05–1.39], p-value = 0.01; respectively) and mortality (OR = 0.78 [95% CI = 0.64–0.96], p-value = 0.02) whereas Tenecteplase 0.40 mg/kg increases the chances of symptomatic intracranial hemorrhage (OR = 2.35 [95% CI = 1.19–4.64], p-value = 0.01). Conclusion: While not conclusive, our study lends evidence to 0.25 mg/kg Tenecteplase dose for ischemic stroke treatment. Further randomized trials need to be done to validate this finding. Registration: International prospective register of systematic reviews (PROSPERO) – CRD42022339774 URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339774

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