A Randomized Trial of Tenecteplase versus Alteplase for Acute Ischemic Stroke

In this phase 2B trial involving 75 patients with acute ischemic stroke, tenecteplase was more effective than alteplase in achieving reperfusion and clinical improvement at 24 hours. Bleeding complications were similar in the two groups. Thrombolytic treatment with alteplase, a recombinant tissue plasminogen activator, for acute ischemic stroke is of proven benefit. 1 However, alteplase is far from ideal, with incomplete and often delayed reperfusion in many patients. 2 Tenecteplase, a genetically engineered mutant tissue plasminogen activator, has some pharmacokinetic advantages over alteplase. 3 A balance between efficacy and risk of bleeding in the treatment of stroke appears to be achieved at a lower dose of tenecteplase than the dose used for myocardial infarction. 4 A recent dose-ranging study of tenecteplase involving patients with acute ischemic stroke, which used standard clinical selection criteria, showed that a dose of 0.4 . . .