Abstract Background and aims Intravenous tenecteplase (0.25 mg/kg) is increasingly utilized in clinical practice, but its efficacy and safety specifically for large vessel occlusion (LVO) stroke across various time windows remain under investigation. We aim to evaluate the impact of tenecteplase in patients with LVO stroke presenting within 24 hours of onset. Methods We searched PubMed, Scopus, Embase, and Cochrane for RCTs comparing tenecteplase with standard care or endovascular thrombectomy (EVT) alone in patients with LVO stroke. The primary outcomes were excellent functional outcome (mRS 0–1) and good functional outcome (mRS 0–2) at 90 days. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Data were synthesized using a fixed-effect model to calculate pooled risk ratios (RR) and 95% confidence intervals (CI). Results A total of 1,763 patients across four RCTs were included. Tenecteplase significantly increased the likelihood of excellent functional outcomes (RR 1.19; 95% CI, 1.03 to1.37; P=0.02) and good functional outcome (RR 1.14; 95% CI, 1.03 to 1.26; P=0.009) at 90 days. There was a significantly higher risk of sICH in the tenecteplase group (RR 1.63; 95% CI, 1.02 to 2.62; P=0.04). However, 90-day mortality did not significantly differ between groups (RR 1.10; 95% CI, 0.89 to 1.36; P=0.38). Conclusions In patients with large vessel occlusion stroke, tenecteplase treatment significantly improves functional independence at 3 months. While this benefit is accompanied by a statistically significant increase in the risk of symptomatic intracranial hemorrhage, there is no corresponding increase in long-term mortality. , supporting its use as a potent reperfusion strategy. Conflict of interest All authors declare that they have nothing to disclose.
Elkoumi et al. (2026) studied this question.