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.

Abstract

Tenecteplase (TNK) is a promising candidate to replace alteplase as the standard of care for acute ischemic stroke (AIS); however, the optimal dosage is still to be investigated. Therefore, we aim to evaluate the safety and efficacy of TNK versus alteplase and to investigate the optimal TNK dosage. A systematic review, pairwise, and network meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, and PubMed until July 26th, 2022. We used the risk ratio (RR) for dichotomous outcomes presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022352038. Nine RCTs with a total of 3,707 patients were included. TNK significantly led to complete recanalization (RR: 1.27 with 95% CI [1.02, 1.57], P = 0.03); however, we found no difference regarding early neurological improvement (RR: 1.07 with 95% CI [0.94, 1.21], P = 0.33) and excellent neurological recovery (RR: 1.03 with 95% CI [0.96, 1.10], P = 0.42). Also, TNK was similar to alteplase regarding mortality (RR: 0.99 with 95% CI [0.82, 1.18], P = 0.88), intracranial haemorrhage (RR: 1.00 with 95% CI [0.85, 1.18], P = 0.99), and parenchymal hematoma (RR: 1.13 with 95% CI [0.83, 1.54], P = 0.44). TNK in the dose of 0.25 mg is a viable candidate to displace alteplase as the standard of care in patients with an AIS within 4.5 h of presentation due to its better rate of early neurological recovery and non-inferiority in terms of safety outcomes. However, the evidence regarding TNK's role in AIS presenting after 4.5 h from symptoms onset, wake-up stroke, and minor stroke/TIA is still lacking, necessitating further double-blinded pragmatic RCTs in this regard.

• Authors: Mohamed Abuelazm, Amith Reddy Seri, Ahmed K Awad, Unaiza Ahmad, Abdelrahman Mahmoud, Ebraheem Albazee, Soumya Kambalapalli, Basel Abdelazeem
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 55 Issue 2 Pg. 322-338 (Feb 2023) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 36449231 (Publication Type: Systematic Review, Meta-Analysis, Journal Article, Review)
• Copyright: © 2022. The Author(s).

Chemical References

• Tissue Plasminogen Activator
• Tenecteplase
• Fibrinolytic Agents

Topics

• Humans
• Tissue Plasminogen Activator (adverse effects)
• Tenecteplase (therapeutic use)
• Fibrinolytic Agents (adverse effects)
• Network Meta-Analysis
• Randomized Controlled Trials as Topic
• Stroke (drug therapy)
• Ischemic Stroke (drug therapy)
• Treatment Outcome
• Brain Ischemia (drug therapy)