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The following is a summary of “Mortality Outcomes with Tenecteplase Versus Alteplase in the Treatment of Massive Pulmonary Embolism,” published in the November 2024 issue of Emergency Medicine by Murphy et al.
Pulmonary embolism (PE) commonly leads to emergency department visits, with thrombolytic agents like alteplase recommended for massive PE, though genetically modified tenecteplase (TNK) offers advantages despite limited comparative studies.
Researchers conducted a retrospective study to assess the safety and mortality of TNK compared to alteplase in patients with PE using an extensive multicenter registry, focusing on mortality, intracranial hemorrhage, and blood transfusions as primary outcomes.
They used the TriNetX Global Health Research Network and assessed adults aged 18 years or older with PE diagnosis (International Classification of Diseases, 10th Revision, Clinical Modification code I26), 2 cohorts were analyzed: TNK-treated (29 organizations, 266 cases) and alteplase-treated (22,864 cases). Propensity matching accounted for demographics, anticoagulant use, comorbidities, and vital sign abnormalities linked to PE severity. Treatment with TNK or alteplase occurred within 7 days of diagnosis, with outcomes assessed 30 days post-thrombolysis.
The results showed that 283 individuals were comparable in demographic characteristics and pre-existing conditions. At 30 days post-thrombolysis, mortality rates were similar between the TNK and alteplase, with rates of 19.4% and 19.8%, respectively (risk ratio 0.982; 95% CI 0.704–1.371). Intracerebral hemorrhage and transfusion rates were too low to allow further analysis.
Investigators concluded that tenecteplase showed comparable mortality to alteplase in PE with hemodynamic instability, supporting its potential for broader use pending further prospective studies.
Source: sciencedirect.com/science/article/abs/pii/S0736467924002373
