2023
DOI: 10.3389/fneur.2023.1176540
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Different doses of tenecteplase vs. alteplase for acute ischemic stroke within 4.5 hours of symptom onset: a network meta-analysis of randomized controlled trials

Abstract: BackgroundThe optimal dose of tenecteplase vs. alteplase for acute ischemic stroke (AIS) has yet to be established. Therefore, we included the latest randomized controlled trials (RCT) to assess the efficacy and safety of different doses of tenecteplase vs. alteplase for AIS within 4.5 hours of symptom onset.MethodsLiterature was searched in PubMed, Cochrane Library, Embase, Web of Science, and clinical trial registries until February 12, 2023. Odds ratios (OR) with 95% credible intervals (CrI) were estimated … Show more

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Cited by 10 publications
(3 citation statements)
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“… 9 Recent network meta-analyses further support this, showing that TNK at the dose of 0.4 mg/kg is at the last rank concerning efficacy in comparison to TNK 0.25 mg/kg and alteplase 0.9 mg/kg, whereas the risk of sICH was the highest with TNK 0.4 mg/kg. 25 , 26 Yet, these analyses were mostly limited to patients presenting within the standard time window (4.5 h). Another trial, the CHinese Acute Tissue-Based Imaging Selection for Lysis In Stroke – Tenecteplase (CHABLIS-T; https://www.clinicaltrials.gov ; Unique identifier: NCT04086147) aimed to specifically investigate two different doses of TNK for the treatment of extended time window AIS.…”
Section: Discussionmentioning
confidence: 99%
“… 9 Recent network meta-analyses further support this, showing that TNK at the dose of 0.4 mg/kg is at the last rank concerning efficacy in comparison to TNK 0.25 mg/kg and alteplase 0.9 mg/kg, whereas the risk of sICH was the highest with TNK 0.4 mg/kg. 25 , 26 Yet, these analyses were mostly limited to patients presenting within the standard time window (4.5 h). Another trial, the CHinese Acute Tissue-Based Imaging Selection for Lysis In Stroke – Tenecteplase (CHABLIS-T; https://www.clinicaltrials.gov ; Unique identifier: NCT04086147) aimed to specifically investigate two different doses of TNK for the treatment of extended time window AIS.…”
Section: Discussionmentioning
confidence: 99%
“…There are some evaluations of tenecteplase and alteplase in the treatment of AIS, e.g., a systematic review and meta-analysis by Rehman et al [ 15 ], which mainly explores different doses, and Rose et al [ 16 ], which focuses on the risk of complications associated with treatment with the two drugs. In addition, there are some network meta-analyses [ 17 , 18 ], but these include not only RCTs but also some other types of clinical studies, which will increase the publication bias of the article and thus have a certain impact on the accuracy of the results. At the same time, some meta-analyses published earlier in 2022 were limited by small sample sizes and the inclusion of observational studies, which were susceptible to information bias and confounding factors, decreasing the reliability of the results.…”
Section: Introductionmentioning
confidence: 99%
“…[16][17][18][19] IVT involves the administration of a thrombolytic agent, such as tissue plasminogen activator (tPA), which dissolves the clot obstructing the cerebral artery. IVT has been demonstrated to improve outcomes in patients with acute ischemic stroke within the first 4.5-h. 14,15,[20][21][22] In 1996, the Food and Drug Administration (FDA) approved intravenous-tPA (IV-tPA) for treating acute ischemic stroke, based on successful outcomes in the National Institute of Neurological Disorders and Stroke study. 23,24 Recently, MT, a type of endovascular treatment for stroke, has gained prominence as a remarkably effective therapy.…”
mentioning
confidence: 99%