Neurol. praxi. 2024;25(6):441-444 | DOI: 10.36290/neu.2024.066

Tenecteplase in ischemic stroke treatment

doc. MUDr. Vladimír Nosáľ, PhD., FESO

Neurologická klinika, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave

Ischemic stroke is a common and serious condition. Timely restoration of cerebral perfusion is crucial for improving patient outcomes and reducing economic impacts. For three decades, alteplase has been the only established pharmacological treatment, often combined with endovascular therapy. Tenecteplase, a newer generation of fibrinolytic therapy, is recommended by the ESO 2023 guidelines as a suitable alternative to alteplase, particularly if treatment is initiated within 4.5 hours of symptom onset. Tenecteplase offers higher fibrin specificity, lower binding to PAI-1, and a longer plasma half-life compared to alteplase, allowing for single bolus administration. Clinical studies have shown that tenecteplase 0.25 mg/kg achieves better recanalization and clinical improvement without increased risk of bleeding. It is equally effective and safe as alteplase, with meta-analyses indicating improved recanalization and clinical outcomes at a lower risk of bleeding. Tenecteplase is a suitable alternative for treating iNCMP, especially within 4.5 hours of symptom onset. Its single bolus administration simplifies hospital management and improves the logistics of transporting patients to specialized centers.

Keywords: thrombolysis, ischemic stroke, tenecteplase, alteplase, reperfusion, thrombectomy.

Received: July 11, 2024; Revised: September 10, 2024; Accepted: October 3, 2024; Prepublished online: October 3, 2024; Published: December 31, 2024  Show citation