Efficacy and Safety of Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Objectives: The varying results of comparing different doses of tenecteplase (TNK) with alteplase (ALT) make it challenging to establish clear guidelines for managing acute ischemic stroke (AIS). This meta-analysis aims to compare the benefits and risks of tenecteplase 0.25 mg/kg versus ALT. Materials & Methods: This study is a comprehensive search of multiple databases to identify randomized controlled trials (RCTs) comparing the effects of TNK 0.25mg/kg and ALT in patients with AIS, until June 10, 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled analyses were performed using Stata V.17. Results: The present study analyzed eight trials involving 3647 patients with AIS who were treated with TNK and ALT. Compared to alteplase, tenecteplase (TNK 0.25 mg/kg) demonstrated a significant improvement in excellent recovery at three months (RR: 1.079, 95% CI 1.00-1.15). TNK exhibited non-inferiority to ALT regarding complete recanalization (RR: 1.47, 95% CI 0.87-2.50), combined complete/partial recanalization (RR: 1.20, 95% CI 0.86-1.68), early neurological improvement (RR: 1.04, 95% CI 0.83-1.29), and good recovery (RR: 1.02, 95% CI 0.90-1.15). While these findings trended in favor of TNK 0.25 mg/kg, the differences did not reach statistical significance. Furthermore, no significant differences were observed between TNK and ALT regarding poor recovery (RR: 0.87, 95% CI 0.67-1.13), parenchymal hematoma (RR: 0.78, 95% CI 0.21-2.81), intracerebral hemorrhage (ICH) (RR: 0.91, 95% CI 0.77-1.08), ICH symptoms (RR: 1.05, 95% CI 0.71-1.56), or 90-day mortality (RR: 1.00, 95% CI 0.83-1.19). Conclusion: Intravenous thrombolysis with TNK 0.25mg/kg in patients with AIS was shown to be as effective and safe as ALT, demonstrating non-inferiority. TNK showed significant superiority in terms of excellent recovery when compared to ALT. However, given the limitations of the present study, further RCTs with larger populations and more specific objectives are needed.
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223159614