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Tenecteplase for Acute Ischemic Stroke: Current Evidence and Practical Considerations

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Abstract

Tenecteplase offers pharmacological advantages over alteplase, and growing evidence supports its consideration for the treatment of patients with acute ischemic stroke. Its ease of administration as a single bolus makes it a preferable agent for patients who need to be urgently transported to a comprehensive stroke center for endovascular therapy (drip and ship) and for patients first evaluated at comprehensive stroke centers who are eligible for endovascular intervention (combined intravenous and endovascular approach). Recent randomized controlled trials indicated that the efficacy of tenecteplase may be similar to that of alteplase in patients with mild strokes and that it is superior to alteplase for patients with more severe strokes from a large vessel occlusion. Cumulative evidence currently favors the use of the 0.25 mg/kg dose. While tenecteplase has not been approved by regulatory agencies in the USA or the EU for the treatment of acute ischemic stroke, ongoing trials and additional clinical experience from countries where it is already being used in practice will likely clarify the role of tenecteplase for the acute management of ischemic stroke in the near future.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 200 First Street SW, Mayo W8B, Rochester, MN, USA

    Alejandro A. Rabinstein

  2. Department of Neurology, Stritch School of Medicine, Loyola University, Chicago, IL, USA

    Esteban Golombievski & Jose Biller

Authors
  1. Alejandro A. Rabinstein
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  2. Esteban Golombievski
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  3. Jose Biller
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Correspondence to Alejandro A. Rabinstein.

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No external funding was used in the preparation of this manuscript.

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Dr. Rabinstein, Dr. Golombievski, and Dr. Biller have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Author contributions

AAR: conception of the review, primary review of the evidence, writing of the manuscript; EG: secondary review of the evidence, critical reviews of the manuscript; JB: conception of the review, critical reviews of the manuscript.

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Rabinstein, A.A., Golombievski, E. & Biller, J. Tenecteplase for Acute Ischemic Stroke: Current Evidence and Practical Considerations. CNS Drugs 34, 1009–1014 (2020). https://doi.org/10.1007/s40263-020-00757-x

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