Tenecteplase vs Alteplase As Bridging Thrombectomy in Ischemic Stroke Patients: A Systematic Review and Meta analysis

Tenecteplase vs Alteplase As Bridging Thrombectomy in Ischemic Stroke Patients: A Systematic Review and Meta analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Tenecteplase vs Alteplase As Bridging Thrombectomy in Ischemic Stroke Patients: A Systematic Review and Meta analysis Salim Harris, Al Rasyid, Mohammad Kurniawan, Rakhmad Hidayat, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5966214/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Aug, 2025 Read the published version in The Egyptian Journal of Neurology, Psychiatry and Neurosurgery → Version 1 posted 8 You are reading this latest preprint version Abstract Background Alteplase (ALT) is the standard medical therapy, and also approved by food and drug administration (FDA) for acute ischemic stroke (AIS) patients who present within 4.5 hours of symptom onset. However, several randomized controlled trials (RCTs) have reported that tenecteplase (TNK) is non-inferior to alteplase. Recently, tenecteplase and alteplase have been compared in acute ischemic stroke patients undergoing mechanical thrombectomy. This study aimed to evaluate the benefits and risks of tenecteplase compared to alteplase in acute ischemic stroke patients undergone thrombectomy. Methods We searched three key databases, including PubMed, Cochrane, and Proquest until November 10, 2024 for clinical studies evaluating the effects of tenecteplase versus alteplase in patients with either large vessel or medium vessel occlusion undergoing mechanical thrombectomy. A fixed-effect meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Nine studies involving 4897 patients, consisting of 1852 patients given tenecteplase (37.8%) and 3045 patients given alteplase (62.2%) were included. Compared to patients given alteplase, patients given tenecteplase showed a significantly higher reperfusion rate as assessed by mTICI 2b-3 criteria (odds ratio 1,23, 95% CI [1,04–1,46], P value = 0,02) without increased risk of adverse event, namely symptomatic intracerebral hemorrhage (OR = 1,04, 95% CI [0,67–1,51], P value = 0,83) or parenchymal hematoma (OR = 0,88, 95% CI [0,67–1,15], P value = 0,34). TNK-treated patients showed the same rate of functional independence (mRS ≤ 2) at 90 days (OR = 1.00, 95% CI [0,83–1,21], P value = 0,99) as ALT-treated patients, but a slightly higher rates of mortality within 90 days (OR = 1,01, 95% CI [0,80–1,28], P value = 0,93). Using albatross plot, tenecteplase showed significantly better in terms of length of stay. Conclusion TNK is superior to ALT in achieving higher reperfusion rate as assessed by mTICI 2b-3 and length of stay. In terms of functional independence (mRS ≤ 2), mortality rate, intracerebral hemmorhage, and parenchymal hematoma, TNK is comparable to ALT. Ischemic stroke tenecteplase alteplase mechanical thrombectomy mRS reperfusion rate mortality symptomatic intracranial hemorrhage parenchymal hematom length of stay Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Aug, 2025 Read the published version in The Egyptian Journal of Neurology, Psychiatry and Neurosurgery → Version 1 posted Editorial decision: Revision requested 10 Jun, 2025 Reviews received at journal 07 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviews received at journal 26 May, 2025 Reviewers agreed at journal 26 May, 2025 Reviewers invited by journal 15 May, 2025 Submission checks completed at journal 12 May, 2025 First submitted to journal 09 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5966214","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":456939369,"identity":"b2edd618-eda1-4a69-ac3b-e2a4be018879","order_by":0,"name":"Salim Harris","email":"","orcid":"","institution":"University of Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Salim","middleName":"","lastName":"Harris","suffix":""},{"id":456939370,"identity":"a959e1dc-0de7-45cb-b588-696b01f54629","order_by":1,"name":"Al Rasyid","email":"","orcid":"","institution":"University of 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Psychiatry and Neurosurgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Ischemic stroke, tenecteplase, alteplase, mechanical thrombectomy, mRS, reperfusion rate, mortality, symptomatic intracranial hemorrhage, parenchymal hematom, length of stay","lastPublishedDoi":"10.21203/rs.3.rs-5966214/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5966214/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAlteplase (ALT) is the standard medical therapy, and also approved by food and drug administration (FDA) for acute ischemic stroke (AIS) patients who present within 4.5 hours of symptom onset. However, several randomized controlled trials (RCTs) have reported that tenecteplase (TNK) is non-inferior to alteplase. Recently, tenecteplase and alteplase have been compared in acute ischemic stroke patients undergoing mechanical thrombectomy. This study aimed to evaluate the benefits and risks of tenecteplase compared to alteplase in acute ischemic stroke patients undergone thrombectomy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe searched three key databases, including PubMed, Cochrane, and Proquest until November 10, 2024 for clinical studies evaluating the effects of tenecteplase versus alteplase in patients with either large vessel or medium vessel occlusion undergoing mechanical thrombectomy. A fixed-effect meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNine studies involving 4897 patients, consisting of 1852 patients given tenecteplase (37.8%) and 3045 patients given alteplase (62.2%) were included. Compared to patients given alteplase, patients given tenecteplase showed a significantly higher reperfusion rate as assessed by mTICI 2b-3 criteria (odds ratio 1,23, 95% CI [1,04\u0026ndash;1,46], P value\u0026thinsp;=\u0026thinsp;0,02) without increased risk of adverse event, namely symptomatic intracerebral hemorrhage (OR\u0026thinsp;=\u0026thinsp;1,04, 95% CI [0,67\u0026ndash;1,51], P value\u0026thinsp;=\u0026thinsp;0,83) or parenchymal hematoma (OR\u0026thinsp;=\u0026thinsp;0,88, 95% CI [0,67\u0026ndash;1,15], P value\u0026thinsp;=\u0026thinsp;0,34). TNK-treated patients showed the same rate of functional independence (mRS\u0026thinsp;\u0026le;\u0026thinsp;2) at 90 days (OR\u0026thinsp;=\u0026thinsp;1.00, 95% CI [0,83\u0026ndash;1,21], P value\u0026thinsp;=\u0026thinsp;0,99) as ALT-treated patients, but a slightly higher rates of mortality within 90 days (OR\u0026thinsp;=\u0026thinsp;1,01, 95% CI [0,80\u0026ndash;1,28], P value\u0026thinsp;=\u0026thinsp;0,93). Using albatross plot, tenecteplase showed significantly better in terms of length of stay.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTNK is superior to ALT in achieving higher reperfusion rate as assessed by mTICI 2b-3 and length of stay. In terms of functional independence (mRS\u0026thinsp;\u0026le;\u0026thinsp;2), mortality rate, intracerebral hemmorhage, and parenchymal hematoma, TNK is comparable to ALT.\u003c/p\u003e","manuscriptTitle":"Tenecteplase vs Alteplase As Bridging Thrombectomy in Ischemic Stroke Patients: A Systematic Review and Meta analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 08:47:32","doi":"10.21203/rs.3.rs-5966214/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-10T16:11:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-07T18:14:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126950603174514764334372115632315250061","date":"2025-06-03T06:03:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-26T15:02:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239585390465241368732121275399120381096","date":"2025-05-26T14:31:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T08:02:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T10:55:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Neurology, Psychiatry and Neurosurgery","date":"2025-05-09T11:02:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-neurology-psychiatry-and-neurosurgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejnp","sideBox":"Learn more about [The Egyptian Journal of Neurology, Psychiatry and Neurosurgery](http://ejnpn.springeropen.com)","snPcode":"41983","submissionUrl":"https://submission.springernature.com/new-submission/41983/3","title":"The Egyptian Journal of Neurology, Psychiatry and Neurosurgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7d21872d-18d9-47ac-98ab-88e25cbbf54c","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:37:58+00:00","versionOfRecord":{"articleIdentity":"rs-5966214","link":"https://doi.org/10.1186/s41983-025-01014-y","journal":{"identity":"the-egyptian-journal-of-neurology-psychiatry-and-neurosurgery","isVorOnly":false,"title":"The Egyptian Journal of Neurology, Psychiatry and Neurosurgery"},"publishedOn":"2025-08-22 16:29:44","publishedOnDateReadable":"August 22nd, 2025"},"versionCreatedAt":"2025-05-16 08:47:32","video":"","vorDoi":"10.1186/s41983-025-01014-y","vorDoiUrl":"https://doi.org/10.1186/s41983-025-01014-y","workflowStages":[]},"version":"v1","identity":"rs-5966214","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5966214","identity":"rs-5966214","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}