Why the study?
Intravenous thrombolysis is a time-dependent reperfusion strategy for acute ischemic stroke, prompting this systematic evaluation of clinical outcomes and prognosis comparing standard alteplase with alternative thrombolytic agents.
Does intravenous thrombolytic therapy with standard alteplase or alternative thrombolytic agents improve 90-day functional independence and prognosis in adults with acute ischemic stroke?
Systematic Review
Does intravenous thrombolytic therapy with standard alteplase or alternative thrombolytic agents improve 90-day functional independence and prognosis in adults with acute ischemic stroke?
In adults with acute ischemic stroke, intravenous alteplase remains the benchmark therapy for improving 90-day functional independence, while tenecteplase offers non-inferior efficacy and safety with logistical administration advantages.
Answers are grounded in this paper and cite their sources.
Supports tenecteplase for simpler emergency dosing in ischemic stroke; extends RCT synthesis for thrombolysis selection.
Background Intravenous thrombolysis is a time-dependent reperfusion strategy for acute ischemic stroke (IS) and requires coordinated, evidence-based care in emergency and stroke unit settings. This systematic review evaluate the clinical outcomes and prognosis of adults with acute ischemic stroke receiving intravenous thrombolytic therapy, comparing standard ALTEplase with alternative thrombolytic agents. Methods A descriptive systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted across PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and LILACS. Randomized controlled trials (RCTs) evaluating intravenous thrombolysis in adults with AIS were included. Quality appraisal was performed using the Cochrane Risk of Bias tool. Results Twelve RCTs were included. ALTEplase (0.9 mg/kg) within 4.5 hours significantly improved 90-day functional independence (modified Rankin Scale 0–1) compared with placebo, despite an increased risk of symptomatic intracranial hemorrhage (sICH). TENECTEplase (0.25 mg/kg) demonstrated non-inferior efficacy and safety relative to ALTEplase, with logistical advantages in administration. RETEplase, recombinant human prourokinase, and non-immunogenic staphylokinase demonstrated acceptable preliminary safety profiles in early-phase trials. Conclusions ALTEplase remains the benchmark therapy, while TENECTEplase represents a safe and practical alternative. Rigorous nursing surveillance and adherence to eligibility protocols are essential to mitigate hemorrhagic risks.
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Silva et al. (2026) conducted a systematic review in Acute ischemic stroke. Intravenous thrombolytic therapy (Alteplase, Tenecteplase, Reteplase, recombinant human prourokinase, non-immunogenic staphylokinase) vs. Placebo or standard Alteplase was evaluated on 90-day functional independence (modified Rankin Scale 0–1).
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