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Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke

PURPOSE OF REVIEW: To review the current evidence and ongoing clinical trials evaluating the efficacy and safety of tenecteplase (TNK), an alternative tissue plasminogen activator (tPA), in the acute management of arterial ischemic stroke (AIS). To date, alteplase is the only tPA approved by the Uni...

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Autores principales: Alhadid, Kenda, Oliveira, Lara, Etherton, Mark R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807245/
https://www.ncbi.nlm.nih.gov/pubmed/36618509
http://dx.doi.org/10.1007/s11936-022-00973-2
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author Alhadid, Kenda
Oliveira, Lara
Etherton, Mark R.
author_facet Alhadid, Kenda
Oliveira, Lara
Etherton, Mark R.
author_sort Alhadid, Kenda
collection PubMed
description PURPOSE OF REVIEW: To review the current evidence and ongoing clinical trials evaluating the efficacy and safety of tenecteplase (TNK), an alternative tissue plasminogen activator (tPA), in the acute management of arterial ischemic stroke (AIS). To date, alteplase is the only tPA approved by the United States FDA for use in AIS. RECENT FINDINGS: There have been multiple phase two and three trials investigating the safety and efficacy of TNK in AIS. In patients with AIS due to large vessel occlusion, one randomized controlled trial demonstrated superiority of TNK for vessel recanalization rates and long-term functional outcomes when compared to alteplase. A meta-analysis of all phase two and three trials evaluating TNK in AIS concluded that TNK has a comparable safety and efficacy profile to alteplase. The results of these trials prompted new recommendations in the Acute Stroke Guideline published by the AHA suggesting it may be reasonable to use as an alternative to alteplase. Furthermore, recent real-world data has also reported decreased door-to-needle time with TNK utilization. SUMMARY: In patients with AIS, use of a thrombolytic agent is standard of care and has been shown to reduce neurological disability and improve functional outcome. Randomized controlled trials have demonstrated that TNK is non-inferior to alteplase from a clinical outcome and safety standpoint. The existing data evaluating the efficacy of TNK compared to alteplase in acute AIS within 4.5 h from symptom onset showed no significant difference between these two agents with regard to functional outcome at 90 days but improved median time to treatment and large vessel recanalization in TNK-treated patients. The results from ongoing TNK trials in larger patient cohorts and in wake-up stroke populations will be instrumental to the wide-scale utilization of TNK in acute AIS management.
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spelling pubmed-98072452023-01-04 Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke Alhadid, Kenda Oliveira, Lara Etherton, Mark R. Curr Treat Options Cardiovasc Med Cerebrovascular Disease and Stroke (S Silverman, Section Editor) PURPOSE OF REVIEW: To review the current evidence and ongoing clinical trials evaluating the efficacy and safety of tenecteplase (TNK), an alternative tissue plasminogen activator (tPA), in the acute management of arterial ischemic stroke (AIS). To date, alteplase is the only tPA approved by the United States FDA for use in AIS. RECENT FINDINGS: There have been multiple phase two and three trials investigating the safety and efficacy of TNK in AIS. In patients with AIS due to large vessel occlusion, one randomized controlled trial demonstrated superiority of TNK for vessel recanalization rates and long-term functional outcomes when compared to alteplase. A meta-analysis of all phase two and three trials evaluating TNK in AIS concluded that TNK has a comparable safety and efficacy profile to alteplase. The results of these trials prompted new recommendations in the Acute Stroke Guideline published by the AHA suggesting it may be reasonable to use as an alternative to alteplase. Furthermore, recent real-world data has also reported decreased door-to-needle time with TNK utilization. SUMMARY: In patients with AIS, use of a thrombolytic agent is standard of care and has been shown to reduce neurological disability and improve functional outcome. Randomized controlled trials have demonstrated that TNK is non-inferior to alteplase from a clinical outcome and safety standpoint. The existing data evaluating the efficacy of TNK compared to alteplase in acute AIS within 4.5 h from symptom onset showed no significant difference between these two agents with regard to functional outcome at 90 days but improved median time to treatment and large vessel recanalization in TNK-treated patients. The results from ongoing TNK trials in larger patient cohorts and in wake-up stroke populations will be instrumental to the wide-scale utilization of TNK in acute AIS management. Springer US 2023-01-02 2023 /pmc/articles/PMC9807245/ /pubmed/36618509 http://dx.doi.org/10.1007/s11936-022-00973-2 Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Cerebrovascular Disease and Stroke (S Silverman, Section Editor)
Alhadid, Kenda
Oliveira, Lara
Etherton, Mark R.
Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
title Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
title_full Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
title_fullStr Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
title_full_unstemmed Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
title_short Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
title_sort intravenous thrombolytics in the treatment of acute ischemic stroke
topic Cerebrovascular Disease and Stroke (S Silverman, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807245/
https://www.ncbi.nlm.nih.gov/pubmed/36618509
http://dx.doi.org/10.1007/s11936-022-00973-2
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