Mahmood Ammad, Muir Keith W
School of Psychology and Neuroscience, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK.
School of Psychology and Neuroscience, Queen Elizabeth University Hospital, University of Glasgow, 1345 Govan Road, Glasgow, G51 4TF UK.
Curr Treat Options Neurol. 2022;24(10):503-513. doi: 10.1007/s11940-022-00733-4. Epub 2022 Jul 30.
Alteplase has been the thrombolytic of choice for acute ischaemic stroke for more than two decades. A thrombolytic which is easier to administer and with improved or comparable safety and efficacy is desirable. Tenecteplase has emerged as a potential successor, and its off-license use in acute ischaemic stroke has increased in recent years. We aimed to examine the evidence base for each drug and discuss their use in varying patient populations in acute ischaemic stroke.
Several trials comparing tenecteplase and alteplase have reported very recently with the results of the ACT trial strengthening the argument in favour of non-inferiority of tenecteplase to alteplase. Ongoing trials such as ATTEST-2 are of interest, and trials such as TASTE and TEMPO-2 will shed further light on use of tenecteplase in specific populations.
A single thrombolytic agent for all indications for thrombolysis in acute ischaemic stroke is desirable in streamlining workflows. Based on recent and upcoming trials, guidelines may soon recommend tenecteplase as a suitable alternative to alteplase. The use of tenecteplase in specific subgroups will depend on further recruitment to ongoing clinical trials.
二十多年来，阿替普酶一直是急性缺血性卒中溶栓治疗的首选药物。人们期望有一种更易于给药且安全性和有效性得到改善或相当的溶栓药物。替奈普酶已成为一种潜在的替代药物，近年来其在急性缺血性卒中的超适应证使用有所增加。我们旨在审查每种药物的证据基础，并讨论它们在急性缺血性卒中不同患者群体中的应用。
最近有几项比较替奈普酶和阿替普酶的试验报告，ACT试验的结果支持替奈普酶不劣于阿替普酶的观点。正在进行的试验，如ATTEST - 2，值得关注，而TASTE和TEMPO - 2等试验将进一步阐明替奈普酶在特定人群中的应用。
在简化工作流程方面，希望有一种单一的溶栓药物用于急性缺血性卒中的所有溶栓适应证。根据近期和即将进行的试验，指南可能很快会推荐替奈普酶作为阿替普酶的合适替代药物。替奈普酶在特定亚组中的应用将取决于正在进行的临床试验的进一步招募情况。
