Summary

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• Alteplase (Activase) is indicated for the treatment of Acute Ischemic Stroke (AIS), Acute Myocardial Infarction (AMI), and Acute Massive Pulmonary Embolism (PE).
• A total of 17 systematic reviews/meta-analyses provided comparative analyses between Tenecteplase and Alteplase.
• The evidence suggests that both drugs have similar efficacy in improving clinical outcomes in patients with AIS. However, some studies suggest that Tenecteplase may be slightly more effective at early vessel recanalization and excellent recovery.
• Safety profiles do not significantly differ between the two drugs. Both carry risks associated with symptomatic intracerebral hemorrhage and mortality; however, certain patient subsets might experience a higher risk of intracranial hemorrhage when treated with Tenecteplase.
• Dosing considerations indicate that a 0.25 mg/kg dosage of Tenecteplase could offer better or equivalent outcomes compared to the standard 0.9 mg/kg dose of Alteplase concerning early neurological improvement and recanalization rates.
• Subgroup analysis reveals nuanced differences in outcomes such as early recanalization rates favoring Tenecteplase among patients with tandem occlusions. Certain patient groups on ACE inhibitors or those having specific comorbidities may have differential risks or outcomes emphasizing personalized treatment considerations.
• Evidence from studies underlines that while both drugs are viable options for treating AIS, ongoing debates exist regarding optimal dosing strategies, especially within varying time windows post-stroke onset considering different stroke severities.
• Tenecteplase's potential effectiveness in achieving early recanalization has been highlighted as an area requiring further investigation within tailored therapeutic strategies.