Silva Gisele Sampaio, Rocha Eva, Pontes-Neto Octávio Marques, Martins Sheila Ouriques
Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
Hospital Israelita Albert Einstein, Centro de Ensino e Pesquisa, São Paulo SP, Brazil.
Arq Neuropsiquiatr. 2025 May;83(5):1-11. doi: 10.1055/s-0045-1808088. Epub 2025 Jun 1.
Tenecteplase (TNK) is a genetically engineered variant of alteplase, showing promise for acute ischemic stroke treatment. With a longer half-life and higher fibrin specificity, TNK enables more targeted and efficient clot dissolution. Clinical trials demonstrate potential advantages, including improved reperfusion rates and functional outcomes with lower systemic bleeding. Though not officially approved for this purpose by all regulatory agencies, TNK is used off-label and in acute stroke guidelines due to its ease of administration and effectiveness. The 0.25 mg/kg dosage within 4.5 hours of symptom onset was shown to be consistently effective and safe. Further trials are expected to identify patient subgroups that benefit most from TNK treatment. The present narrative review assesses the existing literature and evidence regarding the use of tenecteplase for the treatment of acute ischemic stroke.
替奈普酶（TNK）是阿替普酶的基因工程变体，在急性缺血性中风治疗方面显示出前景。TNK具有更长的半衰期和更高的纤维蛋白特异性，能够实现更有针对性和高效的血栓溶解。临床试验证明了其潜在优势，包括更高的再灌注率和功能结局，同时全身出血风险更低。尽管并非所有监管机构都正式批准将其用于此目的，但由于其易于给药和有效性，TNK被用于非适应症用药并被纳入急性中风指南。症状发作后4.5小时内使用0.25mg/kg的剂量已被证明始终有效且安全。预计进一步的试验将确定最能从TNK治疗中获益的患者亚组。本叙述性综述评估了关于使用替奈普酶治疗急性缺血性中风的现有文献和证据。
