Intravenous
alteplase is the only approved treatment for
acute ischemic stroke.
Tenecteplase, a genetically engineered, mutant
tissue plasminogen activator, is an alternative
thrombolytic agent. The economic feasibility of
stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line,
stroke patients cannot meet treatment expenses.
Tenecteplase is easily available (for the management of
acute coronary syndrome) in tertiary-level hospitals of Nepal and the price quote of
tenecteplase ($450) is half the price of
alteplase ($1000). In emergency cases, sometimes, the cost of
alteplase can be greater than the patient can afford and they can't undergo thrombolysis even after arriving on time. However, evidence exists that supports the use of other alternatives (
tenecteplase), which are also effective in the management of
acute ischemic stroke. In this article, we examined current evidence for the efficacy and safety of
tenecteplase when compared to
alteplase. This review will make neurologists in Nepal familiar with the efficacy and safety of
tenecteplase in comparison with
alteplase since it is common for patients to not be able to afford the expensive
alteplase, which makes guideline-based practice impossible some times.