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Efficacy and safety of intravenous tenecteplase compared to alteplase before mechanical thrombectomy in acute ischemic stroke: a meta-analysis

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Název: Efficacy and safety of intravenous tenecteplase compared to alteplase before mechanical thrombectomy in acute ischemic stroke: a meta-analysis
Autoři: Wu, Nihong, Doeppner, Thorsten R., Hermann, Dirk M., Gronewold, Janine
Zdroj: J Neurol
Informace o vydavateli: Springer Science and Business Media LLC, 2024.
Rok vydání: 2024
Témata: Male, Aged, 80 and over, Female [MeSH], Ischemic Stroke/surgery [MeSH], Tenecteplase/administration, Aged, 80 and over [MeSH], Aged [MeSH], Thrombectomy/methods [MeSH], Humans [MeSH], Thrombolysis, Tissue Plasminogen Activator/pharmacology [MeSH], Early recanalization, Tissue Plasminogen Activator/adverse effects [MeSH], Ischemic Stroke/drug therapy [MeSH], Middle Aged [MeSH], Recanalization therapy, Fibrinolytic Agents/adverse effects [MeSH], Fibrinolytic Agents/administration, Male [MeSH], Tissue Plasminogen Activator/administration, Review, Thrombectomy/adverse effects [MeSH], Fibrinolysis, Recombinant tissue-plasminogen activator, Middle Aged, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Tissue Plasminogen Activator, Tenecteplase, Humans, Female, Aged, Ischemic Stroke, Thrombectomy
Popis: Background The benefits and risks of tenecteplase (TNK) versus alteplase (ALT) have recently been assessed in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) with diverse results. Due to its high fibrin specificity and lack of excitotoxicity, TNK may have a higher efficacy and safety profile. This study aimed to evaluate the benefits and risks of TNK compared to ALT in AIS patients prior to thrombectomy. Methods We systematically searched four key databases, PubMed, Embase, Web of Science and Cochrane Library until January 27, 2024 for clinical studies evaluating the effects of TNK versus ALT in patients with large vessel occlusion undergoing MT. A random-effect meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Ten studies involving 3722 patients receiving TNK (1266 patients) or ALT (2456 patients) were included (age: 69.05 ± 14.95 years; 55.64% male). Compared to ALT-treated patients, TNK-treated patients demonstrated significantly higher rates of early recanalization (odds ratio 2.02, 95%-confidence interval 1.20–3.38, p = 0.008) without increased risk of symptomatic intracerebral hemorrhage (1.06, 0.64–1.76, p = 0.82) or intracerebral hemorrhage (1.21, 0.66–2.25, p = 0.54). TNK-treated patients showed similar rates of functional independence at 90 days (1.13, 0.87–1.46, p = 0.37) as ALT-treated patients, but lower rates of mortality within 90 days (0.65, 0.44–0.96, p = 0.03). Conclusion TNK is superior to ALT in achieving early recanalization and is associated with lower mortality within 90 days in AIS patients undergoing MT. Compared with ALT, TNK does not significantly alter functional independence at 90 days, symptomatic intracerebral hemorrhage or intracerebral hemorrhage.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1432-1459
0340-5354
DOI: 10.1007/s00415-024-12445-7
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/38782799
https://repository.publisso.de/resource/frl:6493962
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....86c1f7c1b59401cc2e364b1a7f37bdc4
Databáze: OpenAIRE
Popis
Abstrakt:Background The benefits and risks of tenecteplase (TNK) versus alteplase (ALT) have recently been assessed in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) with diverse results. Due to its high fibrin specificity and lack of excitotoxicity, TNK may have a higher efficacy and safety profile. This study aimed to evaluate the benefits and risks of TNK compared to ALT in AIS patients prior to thrombectomy. Methods We systematically searched four key databases, PubMed, Embase, Web of Science and Cochrane Library until January 27, 2024 for clinical studies evaluating the effects of TNK versus ALT in patients with large vessel occlusion undergoing MT. A random-effect meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Ten studies involving 3722 patients receiving TNK (1266 patients) or ALT (2456 patients) were included (age: 69.05 ± 14.95 years; 55.64% male). Compared to ALT-treated patients, TNK-treated patients demonstrated significantly higher rates of early recanalization (odds ratio 2.02, 95%-confidence interval 1.20–3.38, p = 0.008) without increased risk of symptomatic intracerebral hemorrhage (1.06, 0.64–1.76, p = 0.82) or intracerebral hemorrhage (1.21, 0.66–2.25, p = 0.54). TNK-treated patients showed similar rates of functional independence at 90 days (1.13, 0.87–1.46, p = 0.37) as ALT-treated patients, but lower rates of mortality within 90 days (0.65, 0.44–0.96, p = 0.03). Conclusion TNK is superior to ALT in achieving early recanalization and is associated with lower mortality within 90 days in AIS patients undergoing MT. Compared with ALT, TNK does not significantly alter functional independence at 90 days, symptomatic intracerebral hemorrhage or intracerebral hemorrhage.
ISSN:14321459
03405354
DOI:10.1007/s00415-024-12445-7