Department of Cardiac Surgery, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110000, China.
Department of Nursing, Xinqiao Hospital, Chongqing 400037, China.
Aging (Albany NY). 2023 Dec 26;15(24):14889-14899. doi: 10.18632/aging.205315.
Tenecteplase (TNK), a newer fibrinolytic agent with greater fibrin specificity and longer half-life than alteplase, may has practical advantages over alteplase in acute ischemic stroke (AIS) thrombolysis. We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare different doses of TNK (0.1, 0.25, 0.4 mg/kg) and alteplase in acute ischemic stroke patients. We systematically searched PubMed, Embase and https://clinicaltrials.gov/ for RCTs comparing TNK with alteplase in this population eligible for thrombolysis. The Cochrane Risk of Bias Tool was used to assess study quality. Random-effects or fixed-effects meta-analysis models were used for evaluating all outcomes. Total 10 RCTs with 5097 patients were included. Compared with alteplase, TNK at doses of 0.25 mg/kg may associated with the greatest odds to achieve 90-day excellent independence (mRS score ≤1), but there were no significant differences between other doses of TNK (0.1 mg/kg and 0.4 mg/kg) and alteplase. Among secondary outcomes, no significant differences were found in functional outcome (mRS score ≤2) and mortality at 90 days between any dose of TNK and alteplase. Compared with alteplase, TNK was effective at doses of 0.1 mg/kg and 0.25 mg/kg without increased risk of symptomatic intracerebral hemorrhage (sICH), but patients treated with TNK 0.4 mg/kg showed increased odds of sICH. In conclusion, compared with alteplase, intravenous thrombolysis with TNK at dose of 0.25 mg/kg has a better efficacy and similar safety profile and is a reasonable option for patients with AIS.
替奈普酶（TNK）是一种新型纤维蛋白溶解剂，与阿替普酶相比，其纤维蛋白特异性更强，半衰期更长，在急性缺血性脑卒中（AIS）溶栓治疗中可能具有实际优势。我们旨在对随机对照试验（RCT）进行系统评价和荟萃分析，以比较不同剂量的 TNK（0.1、0.25、0.4mg/kg）与阿替普酶在急性缺血性脑卒中患者中的疗效。我们系统地检索了 PubMed、Embase 和 https://clinicaltrials.gov/，以寻找适合溶栓治疗的该人群中 TNK 与阿替普酶比较的 RCT。使用 Cochrane 偏倚风险工具评估研究质量。使用随机效应或固定效应荟萃分析模型评估所有结局。共纳入 10 项 RCT，共计 5097 例患者。与阿替普酶相比，TNK 0.25mg/kg 剂量可能与 90 天实现良好独立性（mRS 评分≤1）的最大几率相关，但其他剂量的 TNK（0.1mg/kg 和 0.4mg/kg）与阿替普酶之间无显著差异。在次要结局中，任何剂量的 TNK 与阿替普酶在 90 天的功能结局（mRS 评分≤2）和死亡率方面均无显著差异。与阿替普酶相比，TNK 在 0.1mg/kg 和 0.25mg/kg 剂量下有效且不会增加症状性颅内出血（sICH）的风险，但接受 TNK 0.4mg/kg 治疗的患者 sICH 风险增加。总之，与阿替普酶相比，0.25mg/kg 剂量的静脉溶栓治疗 TNK 具有更好的疗效和相似的安全性，是 AIS 患者的合理选择。
