Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.

Autor: Singh A; Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India., Singh MP; Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India., Gaikwad NR; Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India., Kannauje PK; Department of General Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Jazyk: angličtina
Zdroj: Annals of neurosciences [Ann Neurosci] 2024 Apr; Vol. 31 (2), pp. 132-142. Date of Electronic Publication: 2023 Nov 02.
DOI: 10.1177/09727531231193242
Abstrakt: Background: A number of clinical trials have compared tenecteplase (TNK) and alteplase for the management of acute ischemic stroke (AIS) and the results are inconsistent.
Purpose: Present systematic review and meta-analysis is undertaken to analyse the efficacy and safety of TNK in AIS compared to alteplase.
Summary: A thorough literature search was performed through the databases Embase, Cochrane Library, PubMed, and clinicaltrials.gov, for a period from inception to September 2022, with the keywords i.e., "tenecteplase" and "alteplase" and "acute ischemic stroke." Clinical trials published in English that compared the efficacy and safety of TNK to alteplase in AIS were included. The major outcomes of this meta-analysis were proportion of patients free from disability and functional independence at 90 days, early neurological improvement at 24 hours, all-cause mortality at 90 days, patients with intra cranial hemorrhage (ICH), and patients with severe disability at 90 days. A total of nine studies with 3,573 patients were included in the analysis. The proportion of patients with freedom from disability was comparable in both groups (relative risk [RR] = 1.04, 95 per cent CI = 0.92-1.17; p = .53). Similarly, proportion of patients with functional independence was comparable (RR = 1.12, 95 per cent CI = 0.96-1.31; p = .14). TNK group had a higher rate of early neurological recovery (RR = 1.56, 95 per cent CI = 0.96-2.54; p = .07). All-cause mortality at 90 days was comparable in both groups (RR = 0.97; 95 per cent CI = 0.72-1.29; p = .82). The proportion of patients with ICH was higher in TNK group (RR = 1.14, 95 per cent CI = 0.77-1.68; p = .52). The proportion of patients with severe disability was less in TNK group (RR =0.84, 95 per cent CI = 0.53-1.32; p = .44).
Key Message: TNK was similar to alteplase in terms of efficacy and safety. The patients in TNK group showed early neurological improvement but were simultaneously at higher risk of ICH. The TNK can be an alternative to alteplase if the benefits outweigh the risks.
Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
(© The Author(s) 2023.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje