Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: a systematic review and meta-analysis of randomized trials

Abstract

IntroductionAlteplase and tenecteplase are two widely used thrombolytic agents and are both approved for the treatment of acute myocardial infarction. These two molecules have increased fibrin specificity compared with older thrombolytics but distinct pharmacokinetic properties and may differ in terms of risks and benefits. We decided to review the available evidence comparing the safety and efficacy of these two molecules in acute coronary syndrome (ACS) or pulmonary embolism (PE).Material and methodsTo compare the efficacy and safety profile of alteplase and tenecteplase, we systematically searched PubMed, Cochrane and Embase for randomized studies comparing weight-adjusted alteplase to weight-adjusted tenecteplase in patients with ACS or PE. The primary endpoint was the risk of major bleeding, and secondary endpoints were risk of intracranial haemorrhage (ICH), vessel recanalization and 30-day mortality.ResultsThree studies including 17,325 patients with ACS were included in a quantitative meta-analysis. No study compared alteplase to tenecteplase in acute PE. Tenecteplase was associated with a statistically significant reduction of the risk of major bleeding compared to alteplase (RR = 0.79; 95% CI: 0.69–0.90, p = 0.0002). The risk of intracranial haemorrhage (RR = 0.96; 95% CI: 0.71–1.31, p = 0.82) and 30-day mortality (RR = 1.02; 95% CI: 0.9–1.15) were similar in patients treated with alteplase or tenecteplase. No difference was observed in the rate of vessel recanalization.ConclusionsThe available evidence suggests that tenecteplase is associated with a reduced risk of major bleeding compared to alteplase in ACS without evidence of reduced efficacy. These results are however mainly dependent on a single study.

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

“…In fact, the rate of intra hospital death of STEMI has significantly decreased by improving reperfusion method during these years and currently it is between 6% to 14%. 7,8 Coagulation treatment should be done in patients under PCI to limit the side effects of ischemia. However, this treatment can increase the risk of bleeding which is strongly associated with intra hospital and late disasters.…”

Using Tenecteplase for Acute Ischemic Stroke: What Is the Hold Up?

“…A meta-analysis that included that trial and the two other studies referenced above [17][18] was completed, and included a total of 17,325 patients. 19 It found a statistically significant reduction in major bleeding with tenecteplase as compared with alteplase (RR 0.79; 95% CI, 0.69-0.90; p= 0.0002). Another 2017 meta-analysis compared tenecteplase and alteplase along with streptokinase and reteplase for STelevation myocardial infarction.…”

COVID‐19 pandemic: Challenges and solutions from the cardiology pharmacist's perspective

“…2,3 The more fibrin-specific thrombolytics, including tenecteplase, may have a lower risk of major bleeding than other agents. 6 Given the noted benefits of tenecteplase, many of our institutions have emergently added this agent to formulary and/or increased their onsite stock. Given that thrombolytics are infrequently administered for STEMIs, and in order to meet the goal door-to-needle time of 30 minutes, we recommend use of a patient eligibility checklist in order to efficiently determine whether a presenting STEMI patient meets criteria for use.…”