A Narrative Review on Comparison of Tenecteplase and Alteplase in The Management of Acute Ischemic Stroke
Keywords:
(Acute Ischemic Stroke (AIS)), (Alteplase (ALT)), (Tenecteplase (TNK)), (tissue Plasminogen Activator (t-PA)).
Abstract
An acute ischemic stroke (AIS) is life-threatening. Blood flow to a brain region ceases abruptly, prompting the event. This disrupts oxygen and nutrient delivery. It leads to irreversible brain damage or cell death if not fixed soon. Blood clots in cerebral arteries are a common cause of AIS. The main goal of AIS management is to restore blood flow to the affected area quickly. This minimizes tissue loss and improves patient outcomes. Doctors use intravenous Alteplase (ALT), a clot buster. It is the standard treatment for a specific time window after stroke starts. This review looks at the safety and efficacy of Tenecteplase (TNK). It is an emerging clot-busting drug for the management of AIS. It analyses recent research on TNK. It looks at its potential to dissolve blood clots in AIS. It compares its impact on patient recovery to that of ALT. Current data suggests promise for TNK. It is great at unblocking arteries. It speeds recovery in some patient groups. TNK has several potential advantages over ALT, including a longer half-life, simpler administration, stronger clot affinity, slower clearance and possibly better cost-effectiveness. TNK shows promise as a new treatment for AIS. It offers benefits beyond ALT. Further research is necessary to understand its role in AIS management fully.
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27. Shi FE., Yu Z., Sun C., Gao P., Zhang H., Zhu J., “Comparing Adverse Events of Tenecteplase and Alteplase: A Real-World Analysis of the FDA Adverse Event Reporting System (FAERS),” Expert Opinion on Drug Safety, vol. 23, no. 2, pp. 221–229, 2024.
28. Zhu A., Rajendram P., Tseng E., Coutts SB., Yu AY., “Alteplase or Tenecteplase for Thrombolysis in Ischemic Stroke: An Illustrated Review,” Research and Practice in Thrombosis and Haemostasis, vol. 6, no. 6, pp. e12795, 2022
29. Powers WJ., Rabinstein AA., Ackerson T., Adeoye OM., Bambakidis NC., Becker K., Biller J., Brown M., Demaerschalk BM., Hoh B., Jauch EC., “Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association,” Stroke; a Journal of Cerebral Circulation, vol. 50, no. 12, pp. e344–e418, 2019.
2. Huang J., Zheng H., Zhu X., Zhang K., Ping X., “Tenecteplase versus Alteplase for the Treatment of Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials,” Annals of Medicine, vol. 56, no. 1, pp. 2320285, 2024.
3. Mosconi MG., Paciaroni M., “Treatments in Ischemic Stroke: Current and Future,” European Neurology, vol. 85, no. 5, pp. 349–366, 2022.
4. Hollist M., Morgan L., Cabatbat R., Au K., Kirmani M., Kirmani BF., “Acute Stroke Management: Overview and Recent Updates.” Aging and Disease, vol. 12, no. 4, pp. 1000– 1009, 2021.
5. Panezai S., Dubinsky I., Sahito S., Gadallah N., Suhan L., Mehta S., Kirmani J., “Early Experience with Tenecteplase at a Comprehensive Stroke Center,” Neurology. Clinical Practice, vol. 11, no. 6, pp. e885–e889, 2021.
6. Burgos AM., Saver JL., “Evidence That Tenecteplase Is Non-inferior to Alteplase for Acute Ischemic Stroke: Meta-Analysis of 5 Randomized Trials,” Stroke; a Journal of Cerebral Circulation, vol. 50, no. 8, pp. 2156–2162, 2019.
7. Miller SE., Warach SJ., “Evolving Thrombolytics: From Alteplase to Tenecteplase,” Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, vol. 20, no. 3, pp. 664–678, 2023.
8. Li Y., Cui R., Fan F., Lu Y., Ai Y., Liu H., Liu S., Du Y., Qin Z., Sun W., Yu Q., “The Efficacy and Safety of Ischemic Stroke Therapies: An Umbrella Review,” Frontiers in Pharmacology, vol. 13, pp. 924747, 2022.
9. Haley Jr EC., Lyden PD., Johnston KC., Hemmen TM., “TNK in Stroke Investigators. A Pilot Dose-Escalation Safety Study of Tenecteplase in Acute Ischemic Stroke,” Stroke, vol. 36, no. 3, pp. 607–612, 2005.
10. Alhadid K., Oliveira L, Etherton MR., “Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke,” Current Treatment Options in Cardiovascular Medicine, vol. 25, no. 1, pp. 15–28, 2023.
11. Warach SJ., Dula AN., Milling Jr TJ., “Tenecteplase Thrombolysis for Acute Ischemic Stroke,” Stroke; a Journal of Cerebral Circulation, vol. 51, no. 11, pp. 3440–3451, 2020.
12. Palaiodimou L., Katsanos A.H., Turc G., Romoli M., Theodorou A., Lemmens R., Sacco S., Velonakis G., Vlachopoulos C., Tsivgoulis G., “Tenecteplase for the Treatment of Acute Ischemic Stroke in the Extended Time Window: A Systematic Review and MetaAnalysis,” Therapeutic Advances in Neurological Disorders, vol. 17, pp. 17562864231221324, 2024.
13. Li G., Wang C., Wang S., Xiong Y., Zhao X., “Tenecteplase in Ischemic Stroke: Challenge and Opportunity,” Neuropsychiatric Disease and Treatment, vol. 18, pp. 1013–1026, 2022.
14. Requiao LE., Oliveira RS., Reis LS, Assis AP., Moreno BN., Cordeiro LR., Solla DF., “ShortTerm Efficacy Outcomes of Tenecteplase versus Alteplase for Acute Ischemic Stroke: A Meta-Analysis of 5 Randomized Trials,” Neurology India, vol. 70, no. 4, pp. 1454–1459, 2022.
15. Zhang Z., Xi L., Zhang S., Zhang Y., Fan G., Tao X., Gao Q., Xie W., Yang P., Zhai Z., Wang C., “Tenecteplase in Pulmonary Embolism Patients: A Meta-Analysis and Systematic Review,” Frontiers in Medicine, vol. 9, pp. 860565, 2022.
16. Katsanos AH., Psychogios K., Turc G., Sacco S., de Sousa DA., De Marchis GM., Palaiodimou L., Filippou DK., Ahmed N., Sarraj A., Menon BK., “Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis: A Systematic Review and Meta-Analysis,” JAMA Network Open, vol. 5, no. 3, pp. e224506, 2022.
17. Tsivgoulis G., Kargiotis O., De Marchis G., Kohrmann M., Sandset EC., Karapanayiotides T., Sousa DA., Sarraj A., Safouris A., Psychogios K., Vadikolias K., “Off-Label Use of Intravenous Thrombolysis for Acute Ischemic Stroke: A Critical Appraisal of Randomized and Real-World Evidence,” Therapeutic Advances in Neurological Disorders, vol. 14, pp. 1756286421997368, 2021.
18. Marnat G., Lapergue B., Gory B., Kyheng M., Labreuche J., Turc G., Olindo S., Sibon I., Caroff J., Smadja D., Chausson N., “Intravenous Thrombolysis with Tenecteplase versus Alteplase Combined with Endovascular Treatment of Anterior Circulation Tandem Occlusions: A Pooled Analysis of ETIS and TETRIS,” European Stroke Journal, vol. 9, no. 1, pp. 124–134, 2024.
19. Roaldsen MB., Lindekleiv H., Mathiesen EB., “Intravenous Thrombolytic Treatment and Endovascular Thrombectomy for Ischaemic Wake-up Stroke,” Cochrane Database of Systematic Reviews, vol. 12, no. 12, pp. CD010995, 2021.
20. Singh N., Menon BK., Dmytriw A A., Regenhardt RW., Hirsch JA., Ganesh A., “Replacing Alteplase with Tenecteplase: Is the Time Ripe?,” Journal of Stroke, vol. 25, no. 1, pp. 72–80, 2023.
21. Mahmood A., Muir KW., “Tenecteplase or Alteplase: What Is the Thrombolytic Agent of the Future?,” Current Treatment Options in Neurology, vol. 24, no. 10, pp. 503–513, 2022
22. Alemseged F., Campbell BC., “Tenecteplase Thrombolysis in Posterior Circulation Stroke,” Frontiers in Neurology, vol. 12, pp. 678887, 2021.
23. Shen Z., Bao N., Tang M., Yang Y., Li J., Liu W., Jiang G., “Tenecteplase vs. Alteplase for Intravenous Thrombolytic Therapy of Acute Ischemic Stroke: A Systematic Review and MetaAnalysis,” Neurology and Therapy, vol. 12, no. 5, pp. 1553–1572, 2023.
24. Zitek T., Ataya R., Brea I., “Using Tenecteplase for Acute Ischemic Stroke: What Is the Hold Up?” The Western Journal of Emergency Medicine, vol. 21, no. 2, pp. 199–202, 2020.
25. Abuelazm M., Seri AR., Awad AK., Ahmad U., Mahmoud A., Albazee E., Kambalapalli S., Abdelazeem B., “The Efficacy and Safety of Tenecteplase versus Alteplase for Acute Ischemic Stroke: An Updated Systematic Review, Pairwise, and Network Meta-Analysis of Randomized Controlled Trials,” Journal of Thrombosis and Thrombolysis, vol. 55, no. 2, pp. 322–338, 2023.
26. Kobeissi H., Ghozy S., Turfe B., Bilgin C., Kadirvel R., Kallmes DF., Brinjikji W., Rabinstein AA., “Tenecteplase vs. Alteplase for Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Trials,” Frontiers in Neurology, vol. 14, pp. 1102463, 2023.
27. Shi FE., Yu Z., Sun C., Gao P., Zhang H., Zhu J., “Comparing Adverse Events of Tenecteplase and Alteplase: A Real-World Analysis of the FDA Adverse Event Reporting System (FAERS),” Expert Opinion on Drug Safety, vol. 23, no. 2, pp. 221–229, 2024.
28. Zhu A., Rajendram P., Tseng E., Coutts SB., Yu AY., “Alteplase or Tenecteplase for Thrombolysis in Ischemic Stroke: An Illustrated Review,” Research and Practice in Thrombosis and Haemostasis, vol. 6, no. 6, pp. e12795, 2022
29. Powers WJ., Rabinstein AA., Ackerson T., Adeoye OM., Bambakidis NC., Becker K., Biller J., Brown M., Demaerschalk BM., Hoh B., Jauch EC., “Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association,” Stroke; a Journal of Cerebral Circulation, vol. 50, no. 12, pp. e344–e418, 2019.
Published
2024-08-25
How to Cite
K A Ameena Kadar, P A Sreeja, P V Soumya, V J Dawn, V R Irene, & K Surabhi Mohan. (2024). A Narrative Review on Comparison of Tenecteplase and Alteplase in The Management of Acute Ischemic Stroke. Revista Electronica De Veterinaria, 25(1S), 639-645. https://doi.org/10.69980/redvet.v25i1S.803
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Articles
