Efficacy and Safety of Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
- 1Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University, Tehran, Iran
- 2Department of Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
- 3Department of Nursing, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
Abstract
Objectives:: The varying results of comparing different doses of tenecteplase (TNK) with alteplase (ALT) make it challenging to establish clear guidelines for managing acute ischemic stroke (AIS). This meta-analysis aims to compare the benefits and risks of tenecteplase 0.25 mg/kg versus ALT.
Materials & Methods:: This study is a comprehensive search of multiple databases to identify randomized controlled trials (RCTs) comparing the effects of TNK 0.25mg/kg and ALT in patients with AIS, until June 10, 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled analyses were performed using Stata V.17.
Results:: The present study analyzed eight trials involving 3647 patients with AIS who were treated with TNK and ALT. Compared to alteplase, tenecteplase (TNK 0.25 mg/kg) demonstrated a significant improvement in excellent recovery at three months (RR: 1.079, 95% CI 1.00–1.15). TNK exhibited non-inferiority to ALT regarding complete recanalization (RR: 1.47, 95% CI 0.87–2.50), combined complete/partial recanalization (RR: 1.20, 95% CI 0.86–1.68), early neurological improvement (RR: 1.04, 95% CI 0.83–1.29), and good recovery (RR: 1.02, 95% CI 0.90–1.15). While these findings trended in favor of TNK 0.25 mg/kg, the differences did not reach statistical significance. Furthermore, no significant differences were observed between TNK and ALT regarding poor recovery (RR: 0.87, 95% CI 0.67–1.13), parenchymal hematoma (RR: 0.78, 95% CI 0.21–2.81), intracerebral hemorrhage (ICH) (RR: 0.91, 95% CI 0.77–1.08), ICH symptoms (RR: 1.05, 95% CI 0.71–1.56), or 90-day mortality (RR: 1.00, 95% CI 0.83–1.19)
Conclusion:: Intravenous thrombolysis with TNK 0.25mg/kg in patients with AIS was shown to be as effective and safe as ALT, demonstrating non-inferiority. TNK showed significant superiority in terms of excellent recovery when compared to ALT. However, given the limitations of the present study, further RCTs with larger populations and more specific objectives are needed.
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BibTeX
@article{asadi2026efficacy,
title = {{Efficacy and Safety of Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis}},
author = {Fariba Asadi and Zahra Amouzeshi and Hassan Eslami Aliabadi},
journal = {Iranian Journal of Child Neurology},
year = {2026},
month = sep,
doi = {10.22037/ijcn.v20i4.46584},
url = {https://doi.org/10.22037/ijcn.v20i4.46584},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Efficacy and Safety of Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
AU - Fariba Asadi
AU - Zahra Amouzeshi
AU - Hassan Eslami Aliabadi
PY - 2026
DA - 2026/09/01
JO - Iranian Journal of Child Neurology
DO - 10.22037/ijcn.v20i4.46584
UR - https://doi.org/10.22037/ijcn.v20i4.46584
AB - Objectives:: The varying results of comparing different doses of tenecteplase (TNK) with alteplase (ALT) make it challenging to establish clear guidelines for managing acute ischemic stroke (AIS). This meta-analysis aims to compare the benefits and risks of tenecteplase 0.25 mg/kg versus ALT. Materials & Methods:: This study is a comprehensive search of multiple databases to identify randomized controlled trials (RCTs) comparing the effects of TNK 0.25mg/kg and ALT in patients with AIS, until June 10, 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled analyses were performed using Stata V.17. Results:: The present study analyzed eight trials involving 3647 patients with AIS who were treated with TNK and ALT. Compared to alteplase, tenecteplase (TNK 0.25 mg/kg) demonstrated a significant improvement in excellent recovery at three months (RR: 1.079, 95% CI 1.00–1.15). TNK exhibited non-inferiority to ALT regarding complete recanalization (RR: 1.47, 95% CI 0.87–2.50), combined complete/partial recanalization (RR: 1.20, 95% CI 0.86–1.68), early neurological improvement (RR: 1.04, 95% CI 0.83–1.29), and good recovery (RR: 1.02, 95% CI 0.90–1.15). While these findings trended in favor of TNK 0.25 mg/kg, the differences did not reach statistical significance. Furthermore, no significant differences were observed between TNK and ALT regarding poor recovery (RR: 0.87, 95% CI 0.67–1.13), parenchymal hematoma (RR: 0.78, 95% CI 0.21–2.81), intracerebral hemorrhage (ICH) (RR: 0.91, 95% CI 0.77–1.08), ICH symptoms (RR: 1.05, 95% CI 0.71–1.56), or 90-day mortality (RR: 1.00, 95% CI 0.83–1.19) Conclusion:: Intravenous thrombolysis with TNK 0.25mg/kg in patients with AIS was shown to be as effective and safe as ALT, demonstrating non-inferiority. TNK showed significant superiority in terms of excellent recovery when compared to ALT. However, given the limitations of the present study, further RCTs with larger populations and more specific objectives are needed.
SN - 1735-4668
SN - 2008-0700
ER -