Advanced Pharmacotherapy of Tenecteplase for Thrombolysis in Acute Ischemic Stroke Patients
Keywords:
cerebrovascular disease, acute ischemic stroke, thrombolysis, tenecteplaseAbstract
The standard thrombolytic therapy for acute ischemic stroke within 4.5 hours is alteplase which is aimed at improving disability. However, a significant limitation of alteplase is its relatively high risk of intracerebral hemorrhage and its short duration of action; only 9.26% of patients received alteplase within 4.5 hours. Tenecteplase has been developed as an alternative thrombolytic drug. Pharmacokinetic and pharmacodynamic studies have shown that tenecteplase has a longer half-life and greater specificity for fibrin. An advantage of tenecteplase is its ability to be administered via intravenous bolus. According to the 2019 Guidelines for the Early Management of Patients with Acute Ischemic Stroke by the American Heart Association/American Stroke Association, thrombolysis is recommended for both alteplase and tenecteplase. Additionally, evidence from previous studies indicates that tenecteplase has an efficacy and safety profile similar to alteplase. However, tenecteplase appears to be more effective than alteplase in patients with ischemic stroke caused by large vessel occlusions who are undergoing mechanical thrombectomy. Currently, there is still study for evidence supporting the use of tenecteplase in other populations, such as those with ischemic stroke within 4.5 hours who are not eligible for thrombectomy and those with ischemic stroke occurring between 4.5 to 24 hours. Therefore, ongoing studies aim to provide more evidence regarding the benefits of tenecteplase compared to rt-PA for a broader patient population and its cost-effectiveness.
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