Lin Jiashuo, Zuo Wenbo, Jin Huijuan, He Quanwei, Chen Shengcai, Hu Bo, Wan Yan
Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Brain Commun. 2025 Apr 28;7(3):fcaf164. doi: 10.1093/braincomms/fcaf164. eCollection 2025.
Thrombolytic therapy is a cornerstone in managing acute ischaemic stroke, marking significant advancements in treatment. Various generations of thrombolytics play crucial roles in different strategies, including intravenous thrombolysis, bridging therapy and thrombolysis beyond the conventional time window. The continuous development of thrombolytics has brought notable improvements. Compared to first-generation urokinase, second-generation alteplase and third-generation tenecteplase offer significant pharmacological advantages, such as enhanced fibrin specificity and longer half-lives. Tenecteplase demonstrates non-inferiority to alteplase regarding efficacy and safety, with the added benefit of a more convenient administration method. Ongoing trials continue to reveal additional evidence. Furthermore, other thrombolytic agents, including reteplase and non-immunogenic recombinant staphylokinase, are gaining increasing interest in the medical community. This review examines the structural characteristics, pharmacological properties, efficacy and safety profiles of these thrombolytic drugs. It also provides a detailed analysis of the performance of thrombolytic therapy in different acute ischaemic stroke patient subgroups, aiming to trace the evolution of these treatments and compare their effectiveness in acute ischaemic stroke. The goal is to offer a scientific basis for clinical practices and future development of thrombolytic therapies.
溶栓治疗是急性缺血性脑卒中治疗的基石，标志着治疗取得了重大进展。不同代际的溶栓药物在不同策略中发挥着关键作用，包括静脉溶栓、桥接治疗以及超越传统时间窗的溶栓治疗。溶栓药物的不断发展带来了显著改善。与第一代尿激酶相比，第二代阿替普酶和第三代替奈普酶具有显著的药理学优势，如增强的纤维蛋白特异性和更长的半衰期。替奈普酶在疗效和安全性方面不劣于阿替普酶，且给药方法更便捷。正在进行的试验不断揭示更多证据。此外，其他溶栓药物，包括瑞替普酶和非免疫原性重组葡激酶，在医学界正受到越来越多的关注。本综述考察了这些溶栓药物的结构特征、药理学特性、疗效和安全性概况。还对不同急性缺血性脑卒中患者亚组中溶栓治疗的表现进行了详细分析，旨在追溯这些治疗方法的演变，并比较它们在急性缺血性脑卒中中的有效性。目的是为溶栓治疗的临床实践和未来发展提供科学依据。
