Research Paper Volume 15, Issue 24 pp 14889—14899
Tenecteplase versus alteplase for patients with acute ischemic stroke: a meta-analysis of randomized controlled trials
- 1 Department of Cardiac Surgery, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110000, China
- 2 Department of Nursing, Xinqiao Hospital, Chongqing 400037, China
- 3 Department of Critical Care Medicine, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110000, China
- 4 Department of Neurology, Central Hospital of Baoji, Baoji, Shaanxi 721000, China
- 5 Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
Received: July 4, 2023 Accepted: November 6, 2023 Published: December 26, 2023
https://doi.org/10.18632/aging.205315How to Cite
Copyright: © 2023 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Tenecteplase (TNK), a newer fibrinolytic agent with greater fibrin specificity and longer half-life than alteplase, may has practical advantages over alteplase in acute ischemic stroke (AIS) thrombolysis. We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare different doses of TNK (0.1, 0.25, 0.4 mg/kg) and alteplase in acute ischemic stroke patients. We systematically searched PubMed, Embase and https://clinicaltrials.gov/ for RCTs comparing TNK with alteplase in this population eligible for thrombolysis. The Cochrane Risk of Bias Tool was used to assess study quality. Random-effects or fixed-effects meta-analysis models were used for evaluating all outcomes. Total 10 RCTs with 5097 patients were included. Compared with alteplase, TNK at doses of 0.25 mg/kg may associated with the greatest odds to achieve 90-day excellent independence (mRS score ≤1), but there were no significant differences between other doses of TNK (0.1 mg/kg and 0.4 mg/kg) and alteplase. Among secondary outcomes, no significant differences were found in functional outcome (mRS score ≤2) and mortality at 90 days between any dose of TNK and alteplase. Compared with alteplase, TNK was effective at doses of 0.1 mg/kg and 0.25 mg/kg without increased risk of symptomatic intracerebral hemorrhage (sICH), but patients treated with TNK 0.4 mg/kg showed increased odds of sICH. In conclusion, compared with alteplase, intravenous thrombolysis with TNK at dose of 0.25 mg/kg has a better efficacy and similar safety profile and is a reasonable option for patients with AIS.