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

Zitek, Tony; Ataya, Ramsey; Brea, Isabel

doi:10.5811/westjem.2020.1.45279

Cited by 24 publications

(17 citation statements)

References 21 publications

(37 reference statements)

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“…79,[81][82][83] Although alteplase is currently the only FDA-approved tPA medication for AIS, its administration increases the patient's risk of intracranial haemorrhage. 84 Although not FDA-approved for acute stroke, studies have shown that tenecteplase has both a greater fibrin specificity and longer half-life compared to alteplase, resulting in greater reperfusion on imaging studies and superior clinical neurological outcomes at 24 hours. 85,86 However, the benefits of bridging therapy with intravenous thrombolysis remain unclear according to the SKIP studies; this meta-analysis questions the additional benefits of the use of thrombolysis before thrombectomy.…”

Section: Thrombus Composition and Thrombolytic Therapymentioning

confidence: 99%

Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

Jolugbo

Ariëns

2021

Stroke

268

155

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Thrombi retrieved from patients with acute ischemic stroke are highly heterogeneous. Recent data suggest that thrombus composition may impact on mechanical thrombectomy, the number of recanalization manoeuvres, resistance to retrieval, and on thrombolytic potential. Our aim was to summarize evidence describing the impact of thrombus composition on efficacy of mechanical thrombectomy and thrombolysis in patients with acute ischemic stroke. The scoping review methodology guided by the Joanna Briggs Institute, an adaption of the Arksey and O’Malley, was followed. Comprehensive searches were conducted in MEDLINE, EMBASE, SCOPUS, and Web of Science. Articles were classified into 4 key themes: (1) composition of stroke thrombi, (2) thrombus composition and mechanical thrombectomy, (3) thrombus composition and thrombolytic therapy, and (4) novel imaging and endovascular approaches. Our search identified 698 articles published from 1987 to June 2020. Additional articles were extracted from reference lists of the selected articles. Overall, 95 topic-specific articles identified for inclusion published in 40 different journals were included. Reports showed that thrombus composition in stroke was highly heterogeneous, containing fibrin, platelets, red blood cells, VWF (von Willebrand Factor), and neutrophil extracellular traps. Thrombi could roughly be divided into fibrin- and red blood cell–rich clots. Fibrin-rich clots were associated with increased recanalization manoeuvres, longer procedure time, and less favorable clinical outcomes compared with red blood cell–rich clots. Advances in detection or treatment of thrombi that take into account clot heterogeneity may be able to improve future endovascular and thrombolytic treatment of stroke.

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Section: Thrombus Composition and Thrombolytic Therapymentioning

confidence: 99%

Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

Jolugbo

Ariëns

2021

Stroke

268

155

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“…Tenecteplase is also currently cheaper. A 50 mg vial of tenecteplase costs approximately $6300 while a 100 mg vial of alteplase costs approximately $9200 [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Potla¹,

Ganti

2022

Int J Emerg Med

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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.

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“…However, in contrast to the EXTEND-IA TNK trial, similar non-inferior primary and secondary outcomes were also observed when patients with mainly large vessel occlusions and major neurological deficits were included 31 . If other factors such as ease of administration and cost were also taken into account 33 , it makes for a strong case that TNK should be used over alteplase for thrombolysis in ischemic strokes. Perhaps the reluctance to initiate TNK stems from the uncertainty revolving the optimal dose and timing of administration of TNK, which saw a significant degree of heterogeneity in a published meta-analysis conducted 32 .…”

Section: R I P Tmentioning

confidence: 99%

Acute ischemic stroke management: concepts and controversies.A narrative review

Jesuthasan

Kui

et al. 2020

Expert Review of Neurotherapeutics

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

Cited by 24 publications

References 21 publications

Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

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

Acute ischemic stroke management: concepts and controversies.A narrative review

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