Summary

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• This summary is based on the review of 23 systematic review(s)/meta-analysis(es). ^[1-23]
• Complete Recanalization: In Asian patients, tenecteplase achieved significantly higher rates of complete recanalization (relative risk (RR): 1.91, 95% confidence interval (CI): 1.30 to 2.80), while no significant difference was observed in Caucasian patients compared to alteplase (RR: 0.99, 95% CI: 0.87 to 1.14).
• Modified Rankin Scale (mRS): At three months, tenecteplase 0.25 mg/kg ranked highest for achieving mRS 0-1 (surface under the cumulative ranking curve (SUCRA) = 0.68) and mRS 0-2 (SUCRA = 0.86), showing similar effectiveness to alteplase in both outcomes.
• Early Neurological Improvement: Tenecteplase, particularly at the 0.25 mg/kg dose, demonstrated higher rates of early neurological improvement compared to alteplase (OR = 1.52, 95% CI: 1.13-2.05).
• Extended Time Window (>4.5 hours): Tenecteplase 0.25 mg/kg was associated with a higher likelihood of a 3-month excellent functional outcome (mRS ≤1) compared to no thrombolysis (RR = 1.17, 95% CI: 1.01-1.36).
• Mortality: Higher mortality rates were observed with tenecteplase compared to alteplase in Asian patients (RR: 1.18, 95% CI: 0.87-1.62).
• Intracranial Hemorrhage (ICH): Symptomatic and overall ICH rates were similar between tenecteplase and alteplase across various studies, though tenecteplase at 0.40 mg/kg had a higher rate of symptomatic ICH compared to 0.25 mg/kg (RR = 2.39, 95% CrI = 1.00-7.92).
• Symptomatic Intracranial Hemorrhage (sICH): No significant difference was noted between tenecteplase and alteplase for sICH overall, but tenecteplase 0.25 mg/kg was associated with a lower rate of sICH in elderly patients compared to alteplase 0.9 mg/kg.
• Significant differences in effectiveness and safety profiles of tenecteplase were observed between Asian and Caucasian patients, with Asian patients exhibiting higher recanalization rates (RR: 1.91, 95% CI: 1.30 to 2.80) but also higher mortality rates (RR: 1.18, 95% CI: 0.87-1.62). Tenecteplase 0.25 mg/kg demonstrated superior safety in elderly patients concerning symptomatic intracranial hemorrhage compared to alteplase 0.9 mg/kg.