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Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials.

Publication ,  Journal Article
Kheiri, B; Osman, M; Abdalla, A; Haykal, T; Ahmed, S; Hassan, M; Bachuwa, G; Al Qasmi, M; Bhatt, DL
Published in: Journal of thrombosis and thrombolysis
November 2018

Tenecteplase is a genetically mutated variant of alteplase with superior pharmacodynamic and pharmacokinetic properties. However, its efficacy and safety in acute ischemic strokes are limited. Hence, we conducted a study to evaluate the efficacy and safety of tenecteplase compared with alteplase in acute ischemic stroke. Electronic databases were searched for randomized clinical trials (RCTs) comparing tenecteplase with alteplase in acute ischemic stroke patients eligible for thrombolysis. We evaluated various efficacy and safety outcomes using random-effects models for both pairwise and Bayesian network meta-analyses along with meta-regression analyses. We included 5 RCTs with a total of 1585 patients. Compared with alteplase, tenecteplase treatment was associated with significantly greater complete recanalization (odd ratio [OR] 2.01; 95% confidence interval [CI] 1.04-3.87; p = 0.04) and early neurological improvement (OR 1.43; 95% CI 1.01-2.03; p = 0.05). There were no differences between the two thrombolytics in terms of excellent recovery (modified Rankin Scale [mRS] 0-1; OR 1.17; 95% CI 0.95-1.44; p = 0.13), functional independence (mRS 0-2; OR 1.24; 95% CI 0.78-1.98), poor recovery (mRS 4-6; OR 0.78; 95% CI 0.49-1.25; p = 0.31), complete/partial recanalization (OR 1.51; 95% CI 0.70-3.26; p = 0.30), any intracerebral hemorrhage (OR 0.81; 95% CI 0.56-1.17; p = 0.26), symptomatic intracerebral hemorrhage (OR 0.98; 95% CI 0.52-1.83; p = 0.94), or mortality (OR 0.83; 95% CI 0.54-1.26; p = 0.38). In network meta-analysis, there were better efficacy and imaging-based outcomes with tenecteplase 0.25 mg/kg without increased risk of safety outcomes. Our results demonstrate that in acute ischemic stroke, thrombolysis with tenecteplase is at least as effective and safe as alteplase.

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Published In

Journal of thrombosis and thrombolysis

DOI

EISSN

1573-742X

ISSN

0929-5305

Publication Date

November 2018

Volume

46

Issue

4

Start / End Page

440 / 450

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Stroke
  • Randomized Controlled Trials as Topic
  • Network Meta-Analysis
  • Humans
  • Cardiovascular System & Hematology
  • Brain Ischemia
  • 3202 Clinical sciences
 

Citation

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Kheiri, B., Osman, M., Abdalla, A., Haykal, T., Ahmed, S., Hassan, M., … Bhatt, D. L. (2018). Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials. Journal of Thrombosis and Thrombolysis, 46(4), 440–450. https://doi.org/10.1007/s11239-018-1721-3
Kheiri, Babikir, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Sahar Ahmed, Mustafa Hassan, Ghassan Bachuwa, Mohammed Al Qasmi, and Deepak L. Bhatt. “Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials.Journal of Thrombosis and Thrombolysis 46, no. 4 (November 2018): 440–50. https://doi.org/10.1007/s11239-018-1721-3.
Kheiri B, Osman M, Abdalla A, Haykal T, Ahmed S, Hassan M, et al. Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials. Journal of thrombosis and thrombolysis. 2018 Nov;46(4):440–50.
Kheiri, Babikir, et al. “Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials.Journal of Thrombosis and Thrombolysis, vol. 46, no. 4, Nov. 2018, pp. 440–50. Epmc, doi:10.1007/s11239-018-1721-3.
Kheiri B, Osman M, Abdalla A, Haykal T, Ahmed S, Hassan M, Bachuwa G, Al Qasmi M, Bhatt DL. Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials. Journal of thrombosis and thrombolysis. 2018 Nov;46(4):440–450.
Journal cover image

Published In

Journal of thrombosis and thrombolysis

DOI

EISSN

1573-742X

ISSN

0929-5305

Publication Date

November 2018

Volume

46

Issue

4

Start / End Page

440 / 450

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Stroke
  • Randomized Controlled Trials as Topic
  • Network Meta-Analysis
  • Humans
  • Cardiovascular System & Hematology
  • Brain Ischemia
  • 3202 Clinical sciences