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Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis

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Abstract

Background

At present, studies regarding the efficacy and safety of tenecteplase for the treatment of patients with acute ischemic stroke (AIS) are still limited and inconsistent. The purpose of this systematic review and meta-analysis is to compare the efficacy and safety of tenecteplase with alteplase for the treatment of AIS patients.

Methods

Literature search was conducted in PubMed, Embase, and Cochrane Library up to May 10, 2022. Primary outcomes of this study included 90-day good outcome (defined as an mRS score of 0–2) and 90-day excellent outcome (defined as an mRS score of 0–1). Risk ratios (RRs) with 95% confidence intervals (95% CIs) were calculated using a random-effect model for each outcome.

Results

Fourteen studies with a total of 3537 patients were finally included in this meta-analysis. There was no statistical difference between patients receiving tenecteplase and those receiving alteplase in the rates of 90-day good outcome (RR 1.01; 95% CI 0.91–1.13; P = 0.79) and 90-day excellent outcome (RR 1.04; 95% CI 0.92–1.19; P = 0.50). Patients receiving tenecteplase might associated with higher incidence of early neurologic improvement compared with those receiving alteplase (RR 1.29; 95% CI 1.04–1.61; P = 0.02). In addition, no statistical difference was observed between the two groups in other outcomes.

Conclusion

This meta-analysis indicated that tenecteplase in AIS patients is as safe and effective as alteplase and might provide more benefit than alteplase. However, due to several inherent limitations of this study, more prospective studies should be conducted to confirm the above results.

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Data availability statement

Data available in article supplementary material.

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Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China

    Pengju Ma, Xiangsheng Li, Yuling Diao, Haigang Chang & Lei Hui

  2. Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China

    Yi Zhang & Li Chang

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  1. Pengju Ma
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  2. Yi Zhang
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  3. Li Chang
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  4. Xiangsheng Li
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  5. Yuling Diao
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  6. Haigang Chang
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  7. Lei Hui
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Contributions

PM and LH contributed to interpretation of the data, drafting the original manuscript, and the conception and design of this meta-analysis. PM, YZ, and LC contributed to literature search and selection, data extraction, and literature quality assessment. XL, YD, and HC contributed to data analysis, drafting the figures and tables, and revision of the manuscript.

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Correspondence to Pengju Ma or Lei Hui.

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Ethics approval was not required in this study, given the public nature of the data analyzed.

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Ma, P., Zhang, Y., Chang, L. et al. Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis. J Neurol 269, 5262–5271 (2022). https://doi.org/10.1007/s00415-022-11242-4

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