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Abstract Details

Comparative Efficacy and Safety of Tenecteplase and Alteplase in Acute Ischemic Stroke: A Pairwise and Network Meta-analysis of Randomized Controlled Trials
Cerebrovascular Disease and Interventional Neurology
S45 - Cerebrovascular Disease and Interventional Neurology: Meta-analyses and Outcomes Research (1:12 PM-1:24 PM)

Randomized controlled trials (RCTs) exploring the comparative efficacy and safety of tenecteplase and alteplase have been yielding contradictory results on various outcomes. Previous studies have also failed to conduct a dose-wise comparison; this meta-analysis stratifies doses in order to refine our interpretation of outcomes and quantify the benefits and harms of tenecteplase at different doses. 

We aim to conduct a dose-wise comparison of tenecteplase and alteplase on various efficacy and safety outcomes in patients with acute ischemic stroke. 

PubMed/MEDLINE, Cochrane Controlled Register of Trials, and reference lists of the included articles were systematically searched for article retrieval. Several efficacy and safety outcomes were assessed via DerSimonian and Laird random-effects model and reported as Relative Risk at 95% Confidence Interval. Network analysis allowed for a better comparison of doses via indirect collation. Regression analysis was run to identify how outcomes may vary for differing baseline NIHSS scores. 

Ten randomized controlled trials with a total of 4140 patients were included. 2166 (52.32%) patients were enrolled in the tenecteplase group and 1974 (47.68%) in the alteplase group. Tenecteplase at 0.25 mg/kg dose demonstrated significant improvement in excellent functional outcome at 3 months (RR 1.14, 95% CI 1.04-1.26), and early neurological improvement (RR 1.53, 95% CI 1.03-2.26). There was no statistically significant difference between tenecteplase and alteplase in terms of good functional outcome, intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality at any dose. Regression analysis demonstrated no significant impact of baseline NIHSS score on functional outcome and mortality. 

Tenecteplase at 0.25 mg/kg dosage is more efficacious and at least as safe as alteplase for stroke thrombolysis. Newer analyses need to focus on direct comparison of tenecteplase doses and whether tenecteplase is efficacious at longer needle times.

Bakhtawar Ahmad, MBBS
Dr. Ahmad has nothing to disclose.
Aqeeb Ur Rehman Mr. Rehman has nothing to disclose.
Muhammad Aemaz Ur Rehman, MD (University of Alabama) Dr. Aemaz Ur Rehman has nothing to disclose.
Aleenah Mohsin, MBBS Miss Mohsin has nothing to disclose.
Huzaifa Ahmad Cheema, MBBS Dr. Cheema has nothing to disclose.
Afra Zahid, MBBS Miss Zahid has nothing to disclose.
Muhammad Ebaad Ur Rehman, MBBS (Allama Iqbal Medical College ) Mr. Ebaad Ur Rehman has nothing to disclose.
Muhammad Zain Ameer (King Edward Medical University) Mr. Ameer has nothing to disclose.
Muhammad Ayyan, MBBS Mr. Ayyan has nothing to disclose.
Muhammad Ehsan, MBBS Mr. Ehsan has nothing to disclose.
Abia Shahid, MBBS (King Edward Medical University) Ms. Shahid has nothing to disclose.
Ayaz M. Khawaja, MD Dr. Khawaja has nothing to disclose.