The following is a summary of “Tenecteplase for the treatment of acute ischemic stroke in the extended time window: a systematic review and meta-analysis,” published in the January 2024 issue of Neurology by Palaiodimou et al.
Limited outcome data exists for tenecteplase (TNK) administration in ischemic stroke (AIS) beyond the standard time window.
Researchers embarked on a retrospective analysis to evaluate the efficacy and safety of TNK at 0.25 mg/kg for AIS treatment beyond the standard time window.
They involved RCTs comparing TNK 0.25 mg/kg versus no thrombolysis in AIS patients within the extended time window (>4.5 h after last-seen-well or witnessed onset). Eligible studies were uncovered through Medline, Scopus, and international conference abstract searches. Focused on predefined efficacy outcomes at 3 months, including excellent functional outcome (mRS score ⩽1; primary outcome), good functional outcome (mRS ⩽ 2), and less disability (⩾1-point reduction across all mRS scores). Safety endpoints involved symptomatic intracranial hemorrhage (sICH), any ICH, and 3-month mortality. RRs and cORs with corresponding 95% CIs were calculated using a random-effects model.
The results showed 3 RCTs, involving 556 patients treated with TNK versus 560 controls, demonstrated a higher likelihood of a 3-month excellent functional outcome with TNK 0.25 mg/kg compared to controls (RR = 1.17; 95% CI = 1.01–1.36; I-2 = 0%). No notable differences were observed for good functional outcome (RR = 1.05; 95% CI = 0.94–1.17; I-2 = 0%) and reduced disability (adjusted cOR = 1.14; 95% CI = 0.92–1.40; I-2= 0%) at 3 months. Similarities in risks were found for sICH (RR = 1.67; 95% CI = 0.70–4.00; I-2 = 0%), any ICH (RR = 1.08; 95% CI = 0.90–1.29; I-2 = 0%), and 3-month mortality (RR = 1.10; 95% CI = 0.81–1.49; I-2 = 0%) between the groups.
They concluded that 3 RCTs established TNK’s improved efficacy and favorable safety in extended-window AIS, paving the way for further research through ongoing trials.