Key result
Newer thrombolytic agents such as tenecteplase offer potential alternatives to alteplase for acute ischemic stroke, with growing evidence supporting tenecteplase use up to 24 hours from onset.
Why the study?
Alteplase has been the standard thrombolytic for acute ischaemic stroke since 1995, but new alternative agents have emerged, prompting the need to understand their pros, cons, pearls, and pitfalls in care.
Do alternative thrombolytic agents (tenecteplase, prourokinase, reteplase) improve outcomes compared to conventional alteplase in patients with acute ischaemic stroke?
Do alternative thrombolytic agents (tenecteplase, prourokinase, reteplase) improve outcomes compared to conventional alteplase in patients with acute ischaemic stroke?
This review discusses the pros and cons of newer thrombolytic agents compared to alteplase for the management of acute ischaemic stroke.
New thrombolytics under study in AIS leave open whether any surpass alteplase; randomized trials needed before practice change.
Acute ischaemic stroke (AIS) is a leading cause of disability and mortality worldwide. Intravenous thrombolytic therapy is the cornerstone treatments, aiming to restore blood flow in the occluded cerebral vessels. Alteplase has been the standard thrombolytic agent since 1995. However, the exploration of other available thrombolytic agents such as tenecteplase (TNK), prourokinase and reteplase for easier administration, more effective and safer alternatives has led to the development of new agents. 1 Dozens of trials were performed to compare those to conventional alteplase, especially among specific subgroup patients. We would like to illustrate the pearls and pitfalls in AIS care. A better understanding of these new alternative agents will assist clinicians to adhere to the guidelines and yet know the pros and cons of potential options.
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Dong et al. (2025) conducted an editorial in Acute ischemic stroke. Newer thrombolytic agents (tenecteplase, urokinase, prourokinase, reteplase) vs. Alteplase or placebo was evaluated. Newer thrombolytic agents such as tenecteplase offer potential alternatives to alteplase for acute ischemic stroke, with growing evidence supporting tenecteplase use up to 24 hours from onset.
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