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Ahmed HK, Logallo N, Thomassen L, Novotny V, Mathisen SM, Kurz MW. Clinical outcomes and safety profile of Tenecteplase in wake-up stroke. Acta Neurol Scand 2020; 142:475-479. [PMID: 32511749 DOI: 10.1111/ane.13296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tenecteplase has probably pharmacological and clinical advantages in the treatment of acute ischemic stroke. There are lacking data about safety and efficacy of tenecteplase in wake-up stroke (WUPS). AIMS To investigate safety and efficacy of tenecteplase compared to alteplase in WUPS patients included in NOR-TEST. METHODS WUPS patients in NOR-TEST were included in the study based on DWI-FLAIR mismatch. Included patients randomly assigned (1:1) to receive intravenous tenecteplase 0.4 mg/kg (to a maximum of 40 mg) or alteplase 0.9 mg/kg (to a maximum of 90 mg). Neurological improvement was defined as 1) favorable functional outcome at 90 days modified Rankin Scale (mRS) of 0 or 1 and 2) neurological improvement measured with the National Institutes of Health Stroke Scale (NIHSS) of 4 points within 24 hours as compared to admission NIHSS or NIHSS 0 at 24 hours. RESULTS Of 1100 patients from 13 stroke centers included in NOR-TEST, 45 were WUPS patients. Of these, 5 patients were stroke mimics and excluded. Of the remaining 40 patients (3.6%), 24 were treated with alteplase (60%). There was no difference in the number of patients achieving a good clinical outcome (mRS 0-1) in either treatment group. Patients treated with tenecteplase showed a better early neurological improvement (87.5% vs 54.2%, P = 0.027). No ICH was detected on MRI/CT 24-28 hours after thrombolysis. CONCLUSIONS In WUPS patients treated in NOR-TEST, there was no difference in clinical outcomes at 90 days and no ICH events or deaths were observed in either alteplase- or tenecteplase-treated patients. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT01949948.
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Affiliation(s)
- Hassan Khan Ahmed
- Department of Neurology Stavanger University Hospital Stavanger Norway
- Neuroscience Research Group Stavanger University Hospital Stavanger Norway
| | - Nicola Logallo
- Department of Neurosurgery Haukeland University Hospital Bergen Norway
- Center for Neurovascular Diseases Haukeland University Hospital Bergen Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Lars Thomassen
- Center for Neurovascular Diseases Haukeland University Hospital Bergen Norway
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Neurology Haukeland University Hospital Bergen Norway
| | - Vojtech Novotny
- Center for Neurovascular Diseases Haukeland University Hospital Bergen Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Sara M. Mathisen
- Department of Neurology Stavanger University Hospital Stavanger Norway
- Neuroscience Research Group Stavanger University Hospital Stavanger Norway
| | - Martin W. Kurz
- Department of Neurology Stavanger University Hospital Stavanger Norway
- Neuroscience Research Group Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
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Zia-Behbahani M, Hossein H, Kojuri J, Salesi M, Mojtaba M, Keshavarz K. Tenecteplase Versus Reteplase in Acute Myocardial Infarction: A Network Meta-Analysis of Randomized Clinical Trials. Iran J Pharm Res 2020; 18:1622-1631. [PMID: 32641969 PMCID: PMC6934957 DOI: 10.22037/ijpr.2019.1100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute myocardial infarction (AMI) is the leading cause of death throughout the world. One of the standard approaches to treatment of AMI is fibrinolysis. The study was conducted to evaluate the clinical efficacy of tenecteplase versus reteplase through network meta-analysis for AMI. Randomized trials were comprehensively searched in PubMed, Scopus, Cochrane library, and Web of Science using appropriate strategies. Quality assessment was done for the papers. The primary and secondary end-points were mortality, TIMI grade 3 flow at 90 min, death or non-fatal stroke, infarction, total stroke and major bleeding. Odds ratios (OR) were computed (95% confidence intervals). After screening 27325 records, eight articles were included with total patients of 49875 to the meta-analysis. Indirect comparison of tenecteplase vs. reteplase showed no significant differences in the risk of mortality (OR = 0.98, p > 0.05), TIMI grade 3 flow at 90 min (OR = 0.77, p > 0.05), death or non-fatal stroke (OR = 1.04, p > 0.05), infarction (OR = 1.11, p > 0.05), total stroke (OR = 2.71, p > 0.05), and major bleeding (OR = 0.81, p > 0.05) (all p > 0.05). Indirect comparison suggests similar efficacy and safety of tenecteplase and reteplase. Hence, the use of each one of the two medicines depends on price, facility, and accessibility of the medicine.
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Affiliation(s)
- Majid Zia-Behbahani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Hossein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Quality Improvement in Clinical Teaching Research Center, Shiraz Education Center, Faculty of Medical Education, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonins Institute, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Mojtaba Mojtaba
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Health Human Resources Research Center and Department of Health Economic, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center and Department of Health Economic, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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Thommessen B, Næss H, Logallo N, Kvistad CE, Waje-Andreassen U, Ihle-Hansen H, Ihle-Hansen H, Thomassen L, Morten Rønning O. Tenecteplase versus alteplase after acute ischemic stroke at high age. Int J Stroke 2020; 16:295-299. [PMID: 32631157 DOI: 10.1177/1747493020938306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stroke prevalence is increasing with age. Alteplase is the only agent approved for thrombolytic treatment for patients with ischemic stroke, including patients ≥80 years. In the present study, the aim was to compare efficacy and safety of tenecteplase and alteplase in patients ≥80 years. METHODS Data from the Norwegian Tenecteplase Stroke Trial, a randomized controlled trial comparing alteplase and tenecteplase, were assessed. RESULTS Of the 273 patients ≥80 years included, mean age was 85.5 years.In the intention-to-treat analyses, 43.1% receiving tenecteplase and 39.9% receiving alteplase reached excellent functional outcome (modified Rankin Scale score 0-1) after 3 months (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.70-1.85, p=0.59). No significant differences among patients in the two treatment groups regarding frequency of symptomatic intracranial hemorrhage during the first 48 h were identified (11 (8.5%) in the tenecteplase group, 10 (7.0%) in the alteplase group, OR 1.23, 95% CI 0.50-3.00, p 0.65). Death within 3 months occurred in 18 patients (14.3%) in the tenecteplase group and in 21 (15.3%) in the alteplase group (p 0.84). After excluding stroke mimics, the proportion of patients with excellent functional outcome was 44.1% in the tenecteplase group and 34.4% in the alteplase group (OR 1.50 CI 0.90-2.52, p 0.12). CONCLUSION No differences in the efficacy and safety of tenecteplase versus alteplase in patients ≥80 years were identified. TRIAL REGISTRATION Clinicaltrials.gov (NCT01949948).
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Affiliation(s)
- Bente Thommessen
- Department of Neurology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nicola Logallo
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Christopher E Kvistad
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Hege Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ole Morten Rønning
- Department of Neurology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Thelengana A, Radhakrishnan DM, Prasad M, Kumar A, Prasad K. Tenecteplase versus alteplase in acute ischemic stroke: systematic review and meta-analysis. Acta Neurol Belg 2019; 119:359-367. [PMID: 29728903 DOI: 10.1007/s13760-018-0933-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
Tenecteplase is a product of genetic modification of recombinant tissue plasminogen activator with superior pharmacodynamic and pharmacokinetic properties. This meta-analysis was to determine whether intravenous thrombolysis with tenecteplase in patients with acute ischemic stroke has better efficacy and safety outcomes than with intravenous alteplase. PubMed, Cochrane Central Register of Controlled Trials, WHO International clinical trials registry platform (ICTRP), Australian New Zealand Clinical Trials Registry (ANZCTR), EU Clinical Trials Register (EU-CTR) and ClinicalTrials.gov were searched for trials comparing tenecteplase with alteplase in acute ischemic stroke. Functional outcomes (modified Rankin Scale at 90 days), early major neurological improvement, rates of any intracerebral haemorrhage, symptomatic intracerebral haemorrhage and mortality rate at 90 days were the outcomes compared. Four randomized controlled trials involving 1334 patients were included. The Tenecteplase group compared to the alteplase group had significantly better early major neurological improvement (RR = 1.56, 95% CI [1.00, 2.43], p = 0.05). There was no significant difference between tenecteplase and alteplase in excellent functional outcome at 90 days, good functional outcome at 90 days, any intracerebral haemorrhage, symptomatic intracerebral haemorrhage or mortality at 90 days. Our meta-analysis found tenecteplase to be significantly favouring one outcome: early major neurological improvement. Other outcomes did not differ between the tenecteplase and alteplase groups. Trials of cost-effective/benefit analysis comparing tenecteplase versus alteplase and tenecteplase versus endovascular treatment are necessary to reinforce the evidence for the potential cost advantage of tenecteplase.
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Frühwald T, Gärtner U, Stöckmann N, Marxsen JH, Gramsch C, Roessler FC. In vitro examination of the thrombolytic efficacy of tenecteplase and therapeutic ultrasound compared to rt-PA. BMC Neurol 2019; 19:181. [PMID: 31375069 PMCID: PMC6676584 DOI: 10.1186/s12883-019-1404-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Optimizing thrombolytic therapy is vital for improving stroke outcomes. We aimed to develop standardized thrombolysis conditions to evaluate the efficacy of tenecteplase (TNK) compared to the current gold standard rt-PA (alteplase), with and without additional ultrasound treatment. We also wanted to introduce a new analytical approach to quantify fibrin fiber density in transmission electron microscopy (TEM). Methods In vitro clots that are similar to ex vivo clots concerning their histological condition and their durability were generated from whole blood. For five treatment groups we compared relative clot weight loss (each n = 60) and fibrin fiber density in TEM (each n = 5). The control group (A) was treated only with plasma. Two groups were designated for each rt-PA (B + C) and TNK (D + E). Groups C and E were additionally treated with ultrasound. Dosages were 50 μg/ml for rt-PA and 30 μg/ml for TNK. Results were evaluated by using analyses of variance (ANOVA) and post-hoc t-tests. Results Weight loss was increased significantly for all groups compared to the control group. Both TNK groups showed significantly increased weight loss compared to their counterpart rt-PA group (p ≤ 0.001). For TEM only group D showed significantly decreased fibrin fiber density (p < 0.05) compared to both rt-PA groups. Ultrasound did not significantly increase dissolution of clots with either method (best p = 0.16). Conclusions Tenecteplase dissolved clots more effectively than rt-PA with and without ultrasound. A higher sample size could provide more convincing results for TEM.
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Affiliation(s)
- Tobias Frühwald
- Department of Neurology, Justus-Liebig-University Gießen, Klinikstraße 33, 35385, Gießen, Germany
| | - Ulrich Gärtner
- Institute of Anatomy and Cell Biology, Justus-Liebig-University Gießen, Aulweg 123, 35392, Gießen, Germany
| | - Nils Stöckmann
- Department of Neurology, Justus-Liebig-University Gießen, Klinikstraße 33, 35385, Gießen, Germany
| | | | - Carolin Gramsch
- Department of Neuroradiology, Justus-Liebig-University Gießen, Klinikstraße 33, 35385, Gießen, Germany
| | - Florian C Roessler
- Department of Neurology, Justus-Liebig-University Gießen, Klinikstraße 33, 35385, Gießen, Germany. .,Klinik und Poliklinik für Neurologie, Universitätsklinikum Standort Gießen, Klinikstraße 33, 35385, Gießen, Germany.
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Yazdi MMA, Tofighi N, Rajaee T, Ghahremanlou M, Adeli A, Bolhassani A, Azizi M, Davoudi N. Enhancement of Expression Level of Modified t-PA (TNKase) in Leishmania tarentolae by Induction System. Iran Biomed J 2019; 23. [PMID: 30220189 PMCID: PMC6462294 DOI: 10.29252/.23.4.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background The expression of bio-therapeutic proteins in mammalian cells, such as CHO, attains high homogeneity related to post-translational modifications. Although CHO remains the most popular cell line for bestselling biotherapeutic proteins on the market, there are still drawbacks such as expensive culture media, long time line, and high drug cost. Recently, researches on a novel Leishmania protozoan system have confirmed that this low-level eukaryote could represent a competitive alternative to the mammalian cell lines. Methods The full length of coding sequence of modified tPA TNKase (tenecteplase) was synthesized and cloned into an inducible expression vector of L. tarentolae T7-TR cells. Results The expression of the construct was driven by a Tet-inducible promoter. A Leishmania secretory signal sequence was also added to the expression cassette to facilitate the release of the recombinant protein into the medium. The secretory recombinant protein was analyzed and confirmed by SDS-PAGE and Western blot analyses. The expression level of TNKase in this novel system of L. tarentolae was 810 IU/mL after induction, which means that the percentage of expression increases two times compared to previous models in L. tarentolae. The TNKase activity was comparable with Activase. Conclusion Our results suggested that expressed TNK (modified tPA) is functionally compatible with Activase regarding their effect on fibrinolysis. Given the post-translational modification similarities between mammalian and L. tarentolae, it is speculated that this system is capable of producing complex proteins such as tPA similar to mammalian system, with easier manipulation and non-expensive method.
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Affiliation(s)
| | - Nikky Tofighi
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Taraneh Rajaee
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | | | - Ahmad Adeli
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Azam Bolhassani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Azizi
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran,Co-correspondence: Mohammad Azizi Biotechnology Research Center, Pasteur Institute of Iran, Pasteur Sq., 12 Farvardin St., Tehran 1316943551, Iran; E-mail:
| | - Noushin Davoudi
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran,Corresponding Author: Noushin Davoudi Biotechnology Research Center, Pasteur Institute of Iran, Pasteur Sq., 12 Farvardin St., Tehran 1316943551, Iran; Tel. & Fax: (+98-21) 66480780; E-mail: or
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Nelson A, Kelly G, Byyny R, Dionne C, Preslaski C, Kaucher K. Tenecteplase utility in acute ischemic stroke patients: A clinical review of current evidence. Am J Emerg Med 2018; 37:344-348. [PMID: 30471930 DOI: 10.1016/j.ajem.2018.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/14/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Acute ischemic stroke is a leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA. OBJECTIVE This review evaluates literature and utility of tenecteplase for treatment of acute ischemic stroke. DISCUSSION Tenecteplase is modified, third generation fibrinolytic with greater specificity for fibrin bound clots. Current data in acute myocardial infarction suggest decreased bleeding events compared to alteplase. Multiple trials have investigated superiority of tenecteplase compared to tPA for treatment of acute ischemic stroke. Current guidelines designate tenecteplase as an alternative treatment for mild acute ischemic stroke patients based on recent literature. CONCLUSION Recent emerging literature and limited recommendation guidance from governing medical societies leave many emergency medicine providers to weigh benefit versus risk of fibrinolytic therapy and tenecteplase's place in therapy. This review evaluates the available literature regarding tenecteplase and its utility in the treatment of acute ischemic stroke patients.
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Affiliation(s)
- Amelia Nelson
- Denver Health Medical Center, Department of Pharmacy, 777 Bannock ST. MC #0056, Denver, CO 80204, United States of America.
| | - Gregory Kelly
- Penn Medicine, University of Pennsylvania Health System, Department of Pharmacy, 3400 Spruce Street, Philadelphia, PA 19104, United States of America.
| | - Richard Byyny
- Denver Health Medical Center, Department of Emergency Medicine, 777 Bannock ST. MC #0108, Denver, CO 80204, United States of America.
| | - Catherine Dionne
- Denver Health Medical Center, Department of Pharmacy, 777 Bannock ST. MC #0056, Denver, CO 80204, United States of America.
| | - Candice Preslaski
- Denver Health Medical Center, Department of Pharmacy, 777 Bannock ST. MC #0056, Denver, CO 80204, United States of America.
| | - Kevin Kaucher
- Denver Health Medical Center, Department of Pharmacy, 777 Bannock ST. MC #0056, Denver, CO 80204, United States of America.
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Kheiri B, Osman M, Abdalla A, Haykal T, Ahmed S, Hassan M, Bachuwa G, Al Qasmi M, Bhatt DL. Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials. J Thromb Thrombolysis 2018; 46:440-50. [PMID: 30117036 DOI: 10.1007/s11239-018-1721-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tenecteplase is a genetically mutated variant of alteplase with superior pharmacodynamic and pharmacokinetic properties. However, its efficacy and safety in acute ischemic strokes are limited. Hence, we conducted a study to evaluate the efficacy and safety of tenecteplase compared with alteplase in acute ischemic stroke. Electronic databases were searched for randomized clinical trials (RCTs) comparing tenecteplase with alteplase in acute ischemic stroke patients eligible for thrombolysis. We evaluated various efficacy and safety outcomes using random-effects models for both pairwise and Bayesian network meta-analyses along with meta-regression analyses. We included 5 RCTs with a total of 1585 patients. Compared with alteplase, tenecteplase treatment was associated with significantly greater complete recanalization (odd ratio [OR] 2.01; 95% confidence interval [CI] 1.04-3.87; p = 0.04) and early neurological improvement (OR 1.43; 95% CI 1.01-2.03; p = 0.05). There were no differences between the two thrombolytics in terms of excellent recovery (modified Rankin Scale [mRS] 0-1; OR 1.17; 95% CI 0.95-1.44; p = 0.13), functional independence (mRS 0-2; OR 1.24; 95% CI 0.78-1.98), poor recovery (mRS 4-6; OR 0.78; 95% CI 0.49-1.25; p = 0.31), complete/partial recanalization (OR 1.51; 95% CI 0.70-3.26; p = 0.30), any intracerebral hemorrhage (OR 0.81; 95% CI 0.56-1.17; p = 0.26), symptomatic intracerebral hemorrhage (OR 0.98; 95% CI 0.52-1.83; p = 0.94), or mortality (OR 0.83; 95% CI 0.54-1.26; p = 0.38). In network meta-analysis, there were better efficacy and imaging-based outcomes with tenecteplase 0.25 mg/kg without increased risk of safety outcomes. Our results demonstrate that in acute ischemic stroke, thrombolysis with tenecteplase is at least as effective and safe as alteplase.
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Masomi-Bornwassser J, Freguia F, Müller-Werkmeister H, Kempski O, Giese A, Keric N. Effect of irrigation on fibrinolytic rtPA therapy in a clot model of intracerebral haemorrhage: a systematic in vitro study. Acta Neurochir (Wien) 2018; 160:1159-1165. [PMID: 29564653 DOI: 10.1007/s00701-018-3517-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/09/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Although fibrinolytic therapy is an upcoming treatment for intracerebral haemorrhage (ICH), standard guidelines are lacking, and some clinical issues persist. Here, we used our recently devised clot model of ICH to systematically analyse effects of irrigation and cerebrospinal fluid (CSF) on fibrinolysis. METHODS In vitro clots of human blood (25 ml) were generated and a catheter irrigation system was applied to deliver fluid/treatment. Clots were weighed before and after treatment and compared to rtPA treatment alone. First various drainage periods (15, 30 and 60 min; n = 3 each) and irrigation rates (0, 15, 90 and 180 ml/h; n = 3-5 each) were tested, followed by rtPA administration (1 mg, 15 min incubation) at each irrigation rate. Potential fibrinolytic effect of CSF was examined by incubation with 5 ml healthy vs. haemorrhagic CSF (n = 3 each). To assess a washout effect treatment with saline (0.9%), rtPA (1 mg) and high-rate irrigation (180 ml/h) were compared with measuring plasminogen level before and after. Furthermore clots were treated with a combination of plasminogen (150% serum concentration) and rtPA (1 mg). RESULTS Relative clot end weights after 60 min irrigation system treatments were 66.3 ± 3.8% (0 ml/h), 46.3 ± 9.5% (15 ml/h), 46.5 ± 7.1% (90 ml/h) and 53.3 ± 4.1% (180 ml/h). At a lower irrigation rate (15 ml/h), relative end weights were lowest (49.5 ± 4.6%) after 60 min (15 min: 62 ± 4.3%, p = 0.016; 30 min: 62.90 ± 1.88%, p = 0.012). The combination of rtPA and irrigation produced following relative end weights: 0 ml/h, 35 ± 3.2%; 15 ml/h, 32.1 ± 5.7%; 90 ml/h, 36.7 ± 6.3% and 180 ml/h, 41.9 ± 7.5%. No irrigation (0 ml/h) versus rtPA alone showed a significant difference (p < 0.0001) in higher clot weight reduction by rtPA. Similar rtPA+15 ml/h irrigation achieved a significant higher weight reduction compared to 15 ml/h irrigation alone (p = 0.0124). No differences were evident at 90 and 180 ml/h irrigation rates with and without rtPA. Healthy (55.1 ± 5%) or haemorrhagic (65.2 ± 6.2%) CSF showed no fibrinolytic activity. Plasminogen levels in clots declined dramatically (> 80% initially to < 10%) after 1 mg single rtPA dosing and high-rate (180 ml/h) irrigation. The fibrinolytic benefit of adding plasminogen to rtPA was marginal. CONCLUSIONS In our in vitro clot model, irrigation combined with rtPA (vs. rtPA alone) conferred no added lytic benefit. Likewise, exposure to haemorrhagic CSF did not increase clot lysis.
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Affiliation(s)
- Julia Masomi-Bornwassser
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Fabio Freguia
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Neuropathology, University- and Knappschaft- Hospital Bochum, Bochum, Germany
| | - Hendrik Müller-Werkmeister
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Oliver Kempski
- Institute of Neurosurgical Pathophysiology, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- OrthoCentrum Hamburg, Hansastr. 1-3, Hamburg, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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Kate M, Wannamaker R, Kamble H, Riaz P, Gioia LC, Buck B, Jeerakathil T, Smyth P, Shuaib A, Emery D, Butcher K. Penumbral Imaging-Based Thrombolysis with Tenecteplase Is Feasible up to 24 Hours after Symptom Onset. J Stroke 2018; 20:122-130. [PMID: 29402060 PMCID: PMC5836582 DOI: 10.5853/jos.2017.00178] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Thrombolysis >4.5 hours after ischemic stroke onset is unproven. We assessed the feasibility of tenecteplase (TNK) treatment in patients with evidence of an ischemic penumbra 4.5 to 24 hours after onset. METHODS Acute ischemic stroke patients underwent perfusion computed tomography (CT)/magnetic resonance imaging. Patients with cerebral blood volume (CBV) or diffusion weighted imaging Alberta Stroke Program Early CT Scores (ASPECTS) >6 and mismatch score >2 (defined as >2 ASPECTS regions with delay on mean transit time maps and normal CBV) were eligible for treatment with TNK (0.25 mg/kg). Patients with mismatch patterns enrolled in non-endovascular/non-thrombolysis trials and those without mismatch patterns served as comparators. RESULTS The median (interquartile range) baseline National Institutes of Health Stroke Scale (NIHSS) in TNK treated patients (n=16) was 12 (range, 8 to 15). In the untreated mismatch (n=18) and nonmismatch (n=23) groups, the baseline NIHSS was 12 (range, 7 to 12) and 16 (range, 8 to 20; P=0.09) respectively. There was one symptomatic hemorrhage each in the TNK group (parenchymal hematoma [PH] 2) and non-mismatch group (PH 2). Penumbral salvage volumes were higher in TNK treated patients (48.3 mL [range, 24.9 to 80.4]) than the non-mismatch (-90.8 mL [range, -197 to -20]; P<0.0001) patients. CONCLUSIONS This prospective, non-randomized study supports the feasibility of TNK therapy in patients with evidence of ischemic penumbra 4 to 24 hours after onset.
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Affiliation(s)
- Mahesh Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert Wannamaker
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Harsha Kamble
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Parnian Riaz
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Laura C Gioia
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Brian Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Thomas Jeerakathil
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Derek Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Kenneth Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Kathirvel D, Justin Paul G, Prathap Kumar G, Palanisamy G, Gnanavelu G, Ravishankar G, Swaminathan N, Venkatesan S. Tenecteplase versus streptokinase thrombolytic therapy in patients with mitral prosthetic valve thrombosis. Indian Heart J 2017; 70:506-510. [PMID: 30170645 PMCID: PMC6116712 DOI: 10.1016/j.ihj.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 10/19/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Prosthetic valve thrombosis (PVT) is a dreadful complication of mechanical prosthetic valves. Thrombolytic therapy (TT) for PVT is an alternative to surgery and currently making a leading role. This study compares TT with tenecteplase (TNK) and streptokinase (SK) head to head in patients with mitral PVT. Methods In this single center, observational study, patients with mitral PVT diagnosed by clinical data, transthoracic echocardiography, transesophageal echocardiography, and fluoroscopy were included. After excluding patients with contraindications for thrombolysis, they were randomly assigned to receive either SK or TNK regimen. Patients were monitored for success or failure of TT and for any complications. Results Among 52 episodes (47 patients with 5 recurrences) of mechanical mitral PVT, 40 patients were thrombolyzed with SK and 12 patients were thrombolyzed with TNK. Baseline characteristics including demographic profile, clinical and echocardiographic features, and valve types were not statistically significant between the groups. Complete success rate was 77.5% in SK group and 75% in TNK group (p = 0.88). Partial success rate, failure rate, and major complications were not statistically significant between the two groups. Within 12 h of therapy, TNK showed complete success in 33.3% of patients compared to 15% in SK group (p-value <0.02). Minor bleeding was more common in TNK group. Conclusion Slow infusion of TNK is equally efficacious but more effective than SK in the management of mitral mechanical PVT. 75% to 77.5% of PVT patients completely recovered from TT and it should be the first line therapy where the immediate surgical options were remote.
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Affiliation(s)
- D Kathirvel
- Postgraduate in cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India.
| | - Gnanaraj Justin Paul
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - Gorijavaram Prathap Kumar
- Senior Assistant Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - G Palanisamy
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - Ganesan Gnanavelu
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - G Ravishankar
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - N Swaminathan
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - Sangareddi Venkatesan
- Associate Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
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Sinha SK, Sachan M, Goel A, Singh K, Mishra V, Jha MJ, Kumar A, Abdali N, Asif M, Razi M, Pandey U, Thakur R, Varma CM, Krishna V. Efficacy and Safety of Thrombolytic Therapy in Acute Submassive Pulmonary Embolism: Follow-Up Study. J Clin Med Res 2016; 9:163-169. [PMID: 28090232 PMCID: PMC5215020 DOI: 10.14740/jocmr2829w] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Thrombolysis in acute submassive pulmonary embolism (PE) remains controversial. So we studied impact of thrombolytic therapy in acute submassive PE in terms of mortality, hemodynamic status, improvement in right ventricular function, and safety in terms of major and minor bleeding. METHOD A single-center, prospective, randomized study of 86 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. Patients received thrombolysis (single bolus of tenecteplase) with unfractionated heparin (UFH, group I) or placebo with UFH (group II). RESULT Mean age of patients was 54.35 ± 12.8 years with male dominance (M:F = 70%:30%). Smoking was the most common risk factor seen in 29% of all patients, followed by recent history of immobilization (25%), history of surgery or major trauma within past 1 month (15%), dyslipidemia (10%) and diabetes mellitus (10%). Dyspnea was the most common symptom in 80% of all patients, followed by chest pain in 55% and syncope in 6%. Primary efficacy outcome occurred significantly better in group I vs. group II (4.5% vs. 20%; P = 0.04), and significant difference was also found in hemodynamic decompensation (4.5% vs. 20%; P = 0.04), the fall in mean pulmonary artery systolic pressure (PASP) (28.8% vs. 22.5%; P = 0.03), improvement in right ventricular (RV) function (70% vs. 40%; P = 0.001) and mean hospital stay (8.1 ± 2.5 vs. 11.1 ± 2.14 days; P = 0.001). There was no difference in mortality and major bleeding as safety outcome but increased minor bleeding occurred in group I patients (16% vs. 12%; P = 0.04). CONCLUSION Patients with acute submassive PE do not derive overall mortality benefit, recurrent PE and rehospitalization with thrombolytic therapy but had improved clinical outcome in form of decrease in hemodynamic decompensation, mean hospital stay, PASP and improvement of RV function with similar risk of major bleed but at cost of increased minor bleeding.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vikas Mishra
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mukesh Jitendra Jha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ashutosh Kumar
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Nasar Abdali
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohammad Asif
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mahamdula Razi
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
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Lee JP, Park JS, Kwon OW, You YS, Kim SH. Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase, Anti-vascular Endothelial Growth Factor and Gas. Korean J Ophthalmol 2016; 30:192-7. [PMID: 27247518 PMCID: PMC4878979 DOI: 10.3341/kjo.2016.30.3.192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/15/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the visual and anatomical outcomes for neovascular age-related macular degeneration with submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelial growth factor (VEGF) and expansile gas. METHODS This study was a retrospective clinical case series following 25 eyes of 25 patients. All patients received a triple injection using 0.05 mL TNK (50 µg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visual acuity and central retinal thickness were analyzed. RESULTS The mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantly from 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thickness also improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visual improvement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied. CONCLUSIONS A triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration.
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Lahoti HA, Goyal BK. Successful use of Tenecteplase in a patient with recurrence of prosthetic mitral valve thrombosis. Indian Heart J 2015; 67 Suppl 2:S55-7. [PMID: 26688154 DOI: 10.1016/j.ihj.2015.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Tenecteplase can be a more effective and convenient alternative in treatment of prosthetic valve thrombosis (PVT). CASE We hereby present a case of the use of Tenecteplase for recurrence of mitral valve thrombosis in a patient who was brought as an emergency with breathing difficulty at rest. A single intravenous bolus of Tenecteplase relieved her symptoms dramatically within a few hours. This is in contradistinction to her earlier similar presentation with valve thrombosis a year back, when both streptokinase and urokinase had not worked. CONCLUSION The use of Tenecteplase in PVT is reasonable, but needs more documentation. The therapeutic response was remarkable in our case. It is also better suited for recurrence of valve thrombosis as streptokinase cannot be used for a second time.
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Affiliation(s)
- Harshal A Lahoti
- Senior Resident, Department of Cardiology, Bombay Hospital Institute of Medical Sciences, Bombay Hospital, 12, New Marine Lines, Mumbai 400020, India.
| | - Bal Krishna Goyal
- Director, Interventional Cardiology and Hon. Dean, Bombay Hospital Institute of Medical Sciences, Bombay Hospital, 12, New Marine Lines, Mumbai 400020, India
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Paris C, Derex L. [Intravenous thrombolysis in ischemic stroke: Therapeutic perspectives]. Rev Neurol (Paris) 2015; 171:866-75. [PMID: 26563662 DOI: 10.1016/j.neurol.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/11/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022]
Abstract
New therapeutic strategies are under evaluation to improve the treatment of acute ischemic stroke (AIS). Approaches combining intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) and antithrombotic agents are currently evaluated. The combination of IV rt-PA and aspirin showed a high rate of intracranial hemorrhage whereas the association of rt-PA and eptifibatide seems more promising. The results of recent studies evaluating the administration of eptifibatide or argatroban in conjunction with conventional IV thrombolysis with rt-PA are expected to clarify the safety and efficacy of these treatments. More fibrin-specific plasminogen activators, tenecteplase and desmoteplase, are also investigated. These fibrinolytic agents showed a favorable safety profile but their efficacy in AIS remains uncertain. While phase III studies, DIAS-3 and DIAS-4, evaluating IV desmoteplase up to nine hours after stroke onset did not meet the primary endpoint, the results of studies comparing IV tenecteplase and IV rt-PA are expected.
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Affiliation(s)
- C Paris
- Faculté de pharmacie de Lyon, 8, avenue Rockefeller, 69373 Lyon cedex 08, France
| | - L Derex
- Unité neurovasculaire, service de neurologie, hôpital neurologique de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
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66
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Doumiri M, Motia Y, Oudghiri N, Tazi AS. [Systemic thrombolysis with tenecteplase for massive pulmonary embolism after a recent cesarean]. ACTA ACUST UNITED AC 2014; 33:603-5. [PMID: 25450735 DOI: 10.1016/j.annfar.2014.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- M Doumiri
- Service d'anesthésie-réanimation, hôpital maternité Souissi, centre hospitalier universitaire Ibnsina, Rabat, Maroc.
| | - Y Motia
- Service d'anesthésie-réanimation, hôpital maternité Souissi, centre hospitalier universitaire Ibnsina, Rabat, Maroc
| | - N Oudghiri
- Service d'anesthésie-réanimation, hôpital maternité Souissi, centre hospitalier universitaire Ibnsina, Rabat, Maroc
| | - A S Tazi
- Service d'anesthésie-réanimation, hôpital maternité Souissi, centre hospitalier universitaire Ibnsina, Rabat, Maroc
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Chondros K, Karpathakis N, Tsetis D, Sofras F, Mamoulakis C. Systemic thrombolysis with the use of tenecteplase for segmental acute renal in-farction potentially associated with multiple thrombophilic gene polymorphisms. Hippokratia 2014; 18:67-70. [PMID: 25125956 PMCID: PMC4103046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM The potential association of acute renal infarction with multiple thrombophilic gene polymorphisms and the experience of treatment with tenecteplase are described for the first time in the international literature. DESCRIPTION OF THE CASE The case of a 50-year old male with segmental acute renal infarction potentially associated with multiple thrombophilic gene polymorphisms is presented. He was thrombolysed with a single intravenous bolus of tenecteplase in a weight-adjusted dose (0.53mg/Kg bodyweight). Within 30 minutes after drug administration, the patient's symptoms were completely relieved. Patient's clinical course was uneventful with an acceptable renal function outcome eight weeks post-treatment. The following gene polymorphisms were identified: G455A (b-fibrinogen); C677T; A1298C (methylenetetrahydropholate reductase); T196C (platelet glycoprotein IIIa); 4G/5G (plasminogen activator inhibitor-1). CONCLUSION Tenecteplase is a safe and simple to use thrombolytic, with favourable pharmacokinetic profile, which might be useful if administered early, especially when local thrombolysis is impossible or unavailable and therefore warrants further investigation in clinical trials. Hippokratia 2014; 18 (1): 67-70.
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Affiliation(s)
- K Chondros
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - N Karpathakis
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - D Tsetis
- Department of Radiology, Unit of Interventional Radiology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - F Sofras
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - C Mamoulakis
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece ; Department of Urology, General Hospital of Chania "Aghios Georgios", Chania, Crete, Greece
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68
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Iyengar SS, Nair T, Hiremath JS, Jadhav U, Katyal VK, Kumbla D, Sathyamurthy I, Jain RK, Srinivasan M. Pharmacologic reperfusion therapy with indigenous tenecteplase in 15,222 patients with ST elevation myocardial infarction - the Indian Registry. Indian Heart J 2013; 65:436-41. [PMID: 23993004 PMCID: PMC3860598 DOI: 10.1016/j.ihj.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the efficacy and safety of single intravenous bolus administration of indigenously developed tenecteplase (TNK-tPA) in the management of patients with ST-elevation myocardial infarction (STEMI) in clinical practice. METHODS Observational, prescription-event monitoring study. RESULTS Data of 15,222 patients who had STEMI and received weight adjusted TNK injection was analyzed. Overall 95.43% patients had clinically successful thrombolysis (CST). In the different subgroups, hypertensives, diabetics, smokers and hyperlipidemic patients had CST rates comparable to the general patient data. CST rates were significantly lower in the elderly patients (>70 years; 92.11%; p < 0.0001), in patients with history of Ischemic Heart Disease (IHD, 93.86%; p = 0.0004) and in patients receiving delayed treatment (>6 h after onset of chest pain; 85.38%; p < 0.0001). CST was significantly higher in patients who received an early thrombolysis (<3 h after onset of chest pain; 96.54%; p = 0.006). Overall mortality was 1.69%, while it was significantly higher in the elderly (4.42%), patients with history of IHD (2.67%), females (2.93%) and in those who received delayed treatment (4.98%). The overall incidences of intracranial hemorrhage (ICH), bleeding excluding ICH, stroke and ventricular tachyarrhythmia were 0.39%, 2.01%, 0.16% and 2.35% respectively. Age >70 years, diabetes, hyperlipidemia and history of IHD were associated with a higher incidence of heart failure, myocardial re-infarction or ventricular tachyarrhythmias. However, incidence of ICH and bleeding other than ICH was comparable amongst all patient subgroups. CONCLUSION This study confirms the safety and efficacy of indigenous tenecteplase in Indian patients with STEMI, including high risk subgroups. It also highlights the fact that delayed treatment denotes denial of benefits of pharmacologic reperfusion therapy.
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Affiliation(s)
- S S Iyengar
- Head, Department of Cardiology, Manipal Heart Institute, Bangalore 56001, India.
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