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Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Rose, D; Cavalier, A; Kam, W; Cantrell, S; Lusk, J; Schrag, M; Yaghi, S; Stretz, C; de Havenon, A; Saldanha, IJ; Wu, TY; Ranta, A; Barber, PA ...
Published in: Stroke
May 2023

BACKGROUND: Prior systematic reviews have compared the efficacy of intravenous tenecteplase and alteplase in acute ischemic stroke, assigning their relative complications as a secondary objective. The objective of the present study is to determine whether the risk of treatment complications differs between patients treated with either agent. METHODS: We performed a systematic review including interventional studies and prospective and retrospective, observational studies enrolling adult patients treated with intravenous tenecteplase for ischemic stroke (both comparative and noncomparative with alteplase). We searched MEDLINE, Embase, the Cochrane Library, Web of Science, and the www. CLINICALTRIALS: gov registry from inception through June 3, 2022. The primary outcome was symptomatic intracranial hemorrhage, and secondary outcomes included any intracranial hemorrhage, angioedema, gastrointestinal hemorrhage, other extracranial hemorrhage, and mortality. We performed random effects meta-analyses where appropriate. Evidence was synthesized as relative risks, comparing risks in patients exposed to tenecteplase versus alteplase and absolute risks in patients treated with tenecteplase. RESULTS: Of 2226 records identified, 25 full-text articles (reporting 26 studies of 7913 patients) were included. Sixteen studies included alteplase as a comparator, and 10 were noncomparative. The relative risk of symptomatic intracranial hemorrhage in patients treated with tenecteplase compared with alteplase in the 16 comparative studies was 0.89 ([95% CI, 0.65-1.23]; I2=0%). Among patients treated with low dose (<0.2 mg/kg; 4 studies), medium dose (0.2-0.39 mg/kg; 13 studies), and high dose (≥0.4 mg/kg; 3 studies) tenecteplase, the RRs of symptomatic intracranial hemorrhage were 0.78 ([95% CI, 0.22-2.82]; I2=0%), 0.77 ([95% CI, 0.53-1.14]; I2=0%), and 2.31 ([95% CI, 0.69-7.75]; I2=40%), respectively. The pooled risk of symptomatic intracranial hemorrhage in tenecteplase-treated patients, including comparative and noncomparative studies, was 0.99% ([95% CI, 0%-3.49%]; I2=0%, 7 studies), 1.69% ([95% CI, 1.14%-2.32%]; I2=1%, 23 studies), and 4.19% ([95% CI, 1.92%-7.11%]; I2=52%, 5 studies) within the low-, medium-, and high-dose groups. The risks of any intracranial hemorrhage, mortality, and other studied outcomes were comparable between the 2 agents. CONCLUSIONS: Across medium- and low-dose tiers, the risks of complications were generally comparable between those treated with tenecteplase versus alteplase for acute ischemic stroke.

Duke Scholars

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

May 2023

Volume

54

Issue

5

Start / End Page

1192 / 1204

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Stroke
  • Retrospective Studies
  • Prospective Studies
  • Neurology & Neurosurgery
  • Ischemic Stroke
  • Intracranial Hemorrhages
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Rose, D., Cavalier, A., Kam, W., Cantrell, S., Lusk, J., Schrag, M., … Mac Grory, B. (2023). Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke, 54(5), 1192–1204. https://doi.org/10.1161/STROKEAHA.122.042335
Rose, Deborah, Annie Cavalier, Wayneho Kam, Sarah Cantrell, Jay Lusk, Matthew Schrag, Shadi Yaghi, et al. “Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.Stroke 54, no. 5 (May 2023): 1192–1204. https://doi.org/10.1161/STROKEAHA.122.042335.
Rose D, Cavalier A, Kam W, Cantrell S, Lusk J, Schrag M, et al. Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2023 May;54(5):1192–204.
Rose, Deborah, et al. “Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.Stroke, vol. 54, no. 5, May 2023, pp. 1192–204. Pubmed, doi:10.1161/STROKEAHA.122.042335.
Rose D, Cavalier A, Kam W, Cantrell S, Lusk J, Schrag M, Yaghi S, Stretz C, de Havenon A, Saldanha IJ, Wu TY, Ranta A, Barber PA, Marriott E, Feng W, Kosinski AS, Laskowitz D, Poli S, Mac Grory B. Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2023 May;54(5):1192–1204.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

May 2023

Volume

54

Issue

5

Start / End Page

1192 / 1204

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Stroke
  • Retrospective Studies
  • Prospective Studies
  • Neurology & Neurosurgery
  • Ischemic Stroke
  • Intracranial Hemorrhages
  • Humans