Summary

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• This summary is based on the review of 42 systematic review(s)/meta-analysis(es). ^[1-42]
• Excellent Functional Outcome (mRS 0-1 at 3 months): Tenecteplase was associated with higher likelihoods of achieving excellent functional outcomes compared to alteplase, with some studies showing significant differences (RR (relative risk) = 1.05, 95% CI (confidence interval): 1.01-1.10, p=0.012) and (OR (odds ratio) = 1.15, 95% CI: 1.01-1.32), although others reported no significant difference (OR = 1.08, 95% CI: 0.93-1.26) and (OR = 1.10, 95% CI: 0.98-1.23).
• Good Functional Outcome (mRS 0-2 at 3 months): Similar good functional outcomes were reported between tenecteplase and alteplase in several studies (RR = 1.03, 95% CI: 0.99-1.07), with some reports indicating tenecteplase’s superiority over placebo but comparability to alteplase (OR = 1.54, 95% CI: 1.19-1.98).
• Early Neurological Improvement: Tenecteplase showed a higher rate of early neurological improvement, with significant early recanalization (OR = 2.02, 95% CI: 1.20-3.38) and enhanced early neurological recovery (OR = 1.53, 95% CI: 1.03-2.26).
• Tenecteplase was associated with significantly higher rates of early vessel recanalization compared to alteplase (OR = 2.07, 95% CI: 1.19-3.59), with particularly improved outcomes in Asian patients.
• Symptomatic Intracranial Hemorrhage (sICH): The incidence of sICH was similar between tenecteplase and alteplase across multiple studies, including reports with RR = 1.12, 95% CI 0.83-1.53; OR = 1.12, 95% CI 0.79-1.59; OR = 1.06, 95% CI 0.70-1.60.
• Mortality: Three-month mortality rates were comparable between tenecteplase and alteplase (RR = 0.97, 95% CI 0.82-1.15 and OR = 0.99, 95% CI 0.83-1.19), though moderate certainty evidence suggested that tenecteplase may reduce all-cause mortality (aOR = 0.44, 95% CI 0.30-0.64).
• Tenecteplase demonstrated higher rates of complete recanalization in Asian patients compared to Caucasian patients, though Asian patients also experienced higher mortality rates. In patients older than 80 years, tenecteplase at a 0.25 mg/kg dose was associated with improved 90-day modified Rankin Scale scores and reduced mortality relative to alteplase, with no observed differences among younger patients.