Pharmacology of alteplase VS tenecteplase in acute ischemic stroke
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Aug 21, 2023
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Abstract
Administration of rtPA thrombolysis intravenously (IV) as the management of acute ischemic stroke currently shows satisfactory results in overcoming ischemic stroke attacks which can reduce morbidity and mortality. This study aims to analyze the comparison of alteplase vs tenecteplase therapy in patients with acute ischemic stroke in terms of the benefits, safety and risks of both drugs. Article searches were conducted through Google Scholar and Research Gate using the keywords Pharmacology Tenecteplase and Alteplase in Acute Ischemic Stroke, then a total of 25 articles that met the inclusion criteria were reviewed. The results showed that tenecteplase had a fibrin specificity 14 times greater than alteplase, a longer half-life, slower plasma clearance, and 80-fold greater resistance to type 1 plasminogen activator inhibitor (PAI-1). Its half-life of about 18 minutes allows rapid administration of a single bolus. The efficacy in acute ischemic stroke was shown to be significantly higher than tenecteplase with significant initial neurologic improvement. Regarding the safety assessment, there was no difference related to all levels of symptomatic intracerebral hemorrhage, both tenecteplase and alteplase.
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How to Cite
Nova, R. (2023) “Pharmacology of alteplase VS tenecteplase in acute ischemic stroke”, Science Midwifery, 11(3), pp. 545-553. doi: 10.35335/midwifery.v11i3.1285.
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Amarenco, P., Lavallée, P. C., Monteiro Tavares, L., Labreuche, J., Albers, G. W., Abboud, H., ... & Wong, L. K. (2018). Five-year risk of stroke after TIA or minor ischemic stroke. New England Journal of Medicine, 378(23), 2182-2190.
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Bagoly, Z., Szegedi, I., Kálmándi, R., Tóth, N. K., & Csiba, L. (2019). Markers of coagulation and fibrinolysis predicting the outcome of acute ischemic stroke thrombolysis treatment: a review of the literature. Frontiers in neurology, 10, 513.
Bambari, H. A., Panda, A. L., & Joseph, V. F. (2021). Terapi Reperfusi pada Infark Miokard dengan ST-Elevasi. e-CliniC, 9(2), 287-298.
Behrouz, R. (2014). Intravenous tenecteplase in acute ischemic stroke: an updated review. Journal of neurology, 261, 1069-1072.
Berge, E., Whiteley, W., Audebert, H., De Marchis, G. M., Fonseca, A. C., Padiglioni, C., ... & Turc, G. (2021). European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. European stroke journal, 6(1), I-LXII.
Coutts, S. B., Berge, E., Campbell, B. C., Muir, K. W., & Parsons, M. W. (2018). Tenecteplase for the treatment of acute ischemic stroke: a review of completed and ongoing randomized controlled trials. International Journal of Stroke, 13(9), 885-892.
Haley Jr, E. C., Thompson, J. L., Grotta, J. C., Lyden, P. D., Hemmen, T. G., Brown, D. L., ... & Levin, B. (2010). Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke, 41(4), 707-711.
Khatri, P., Kleindorfer, D. O., Devlin, T., Sawyer, R. N., Starr, M., Mejilla, J., ... & PRISMS Investigators. (2018). Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial. Jama, 320(2), 156-166.
Klok, F. A., Pruszczyk, P., & Konstantinides, S. V. (2023). Thrombolytic treatment of life-threatening pulmonary embolism in times of alteplase shortage. European Heart Journal, 44(20), 1837-1839.
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Ma, P., Zhang, Y., Chang, L., Li, X., Diao, Y., Chang, H., & Hui, L. (2022). Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis. Journal of Neurology, 269(10), 5262-5271.
Moncharmont, P., Barday, G., & Benamara, H. (2020). Adverse transfusion reactions with neurological signs in transfused patients. Transfusion Clinique et Biologique, 27(2), 87-90.
Muresanu, D. F., Strilciuc, S., & Stan, A. (2019). Current drug treatment of acute ischemic stroke: challenges and opportunities. CNS drugs, 33, 841-847.
Nandi, S. (2020). Synthetic Platelet-like Particles for the Enhancement of Wound Healing Outcomes. North Carolina State University.
Olindo, S., Albucher, J. F., Bejot, Y., Berge, J., Cordonnier, C., Guillon, B., ... & Sibon, I. (2022). Tenecteplase in acute ischemic stroke: Review of the literature and expert consensus from the French Neurovascular Society. Revue Neurologique.
Putaala, J., Saver, J. L., Nour, M., Kleindorfer, D., McDermott, M., & Kaste, M. (2021). Should tenecteplase be given in clinical practice for acute ischemic stroke thrombolysis?. Stroke, 52(9), 3075-3080.
Psychogios, K., Palaiodimou, L., Katsanos, A. H., Magoufis, G., Safouris, A., Kargiotis, O., ... & Tsivgoulis, G. (2021). Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion. Therapeutic Advances in Neurological Disorders, 14, 1756286420986727.
Ratziu, V., De Guevara, L., Safadi, R., Poordad, F., Fuster, F., Flores-Figueroa, J., ... & Sanyal, A. J. (2021). Aramchol in patients with nonalcoholic steatohepatitis: a randomized, double-blind, placebo-controlled phase 2b trial. Nature Medicine, 27(10), 1825-1835.
Tanswell, P., Modi, N., Combs, D., & Danays, T. (2002). Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction. Clinical pharmacokinetics, 41, 1229-1245.
Thelengana, A., Radhakrishnan, D. M., Prasad, M., Kumar, A., & Prasad, K. (2019). Tenecteplase versus alteplase in acute ischemic stroke: systematic review and meta-analysis. Acta Neurologica Belgica, 119, 359-367.
Xu, N., Chen, Z., Zhao, C., Xue, T., Wu, X., Sun, X., & Wang, Z. (2018). Different doses of tenecteplase vs alteplase in thrombolysis therapy of acute ischemic stroke: evidence from randomized controlled trials. Drug Design, Development and Therapy, 2071-2084.
Yamamoto, A., Hattammaru, Y., & Uezono, S. (2020). Spontaneous intracranial hypotension associated with cerebral venous thrombosis detected by a sudden seizure: a case report. JA Clinical Reports, 6, 1-7.
Yu, W., Yin, N., Yang, Y., Xuan, C., Liu, X., Liu, W., ... & Shi, J. (2022). Rescuing ischemic stroke by biomimetic nanovesicles through accelerated thrombolysis and sequential ischemia-reperfusion protection. Acta Biomaterialia, 140, 625-640.
Anderson, C. S., Huang, Y., Lindley, R. I., Chen, X., Arima, H., Chen, G., ... & Yen, M. B. (2019). Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. The Lancet, 393(10174), 877-888.
Amarenco, P., Lavallée, P. C., Monteiro Tavares, L., Labreuche, J., Albers, G. W., Abboud, H., ... & Wong, L. K. (2018). Five-year risk of stroke after TIA or minor ischemic stroke. New England Journal of Medicine, 378(23), 2182-2190.
Aspers, P., & Corte, U. (2019). What is qualitative in qualitative research. Qualitative sociology, 42, 139-160.
Bagoly, Z., Szegedi, I., Kálmándi, R., Tóth, N. K., & Csiba, L. (2019). Markers of coagulation and fibrinolysis predicting the outcome of acute ischemic stroke thrombolysis treatment: a review of the literature. Frontiers in neurology, 10, 513.
Bambari, H. A., Panda, A. L., & Joseph, V. F. (2021). Terapi Reperfusi pada Infark Miokard dengan ST-Elevasi. e-CliniC, 9(2), 287-298.
Behrouz, R. (2014). Intravenous tenecteplase in acute ischemic stroke: an updated review. Journal of neurology, 261, 1069-1072.
Berge, E., Whiteley, W., Audebert, H., De Marchis, G. M., Fonseca, A. C., Padiglioni, C., ... & Turc, G. (2021). European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. European stroke journal, 6(1), I-LXII.
Coutts, S. B., Berge, E., Campbell, B. C., Muir, K. W., & Parsons, M. W. (2018). Tenecteplase for the treatment of acute ischemic stroke: a review of completed and ongoing randomized controlled trials. International Journal of Stroke, 13(9), 885-892.
Haley Jr, E. C., Thompson, J. L., Grotta, J. C., Lyden, P. D., Hemmen, T. G., Brown, D. L., ... & Levin, B. (2010). Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke, 41(4), 707-711.
Khatri, P., Kleindorfer, D. O., Devlin, T., Sawyer, R. N., Starr, M., Mejilla, J., ... & PRISMS Investigators. (2018). Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial. Jama, 320(2), 156-166.
Klok, F. A., Pruszczyk, P., & Konstantinides, S. V. (2023). Thrombolytic treatment of life-threatening pulmonary embolism in times of alteplase shortage. European Heart Journal, 44(20), 1837-1839.
Kvistad, C. E., Næss, H., Helleberg, B. H., Idicula, T., Hagberg, G., Nordby, L. M., ... & Thomassen, L. (2022). Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. The Lancet Neurology, 21(6), 511-519.
Logallo, N., Novotny, V., Assmus, J., Kvistad, C. E., Alteheld, L., Rønning, O. M., ... & Thomassen, L. (2017). Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. The Lancet Neurology, 16(10), 781-788.
Ma, P., Zhang, Y., Chang, L., Li, X., Diao, Y., Chang, H., & Hui, L. (2022). Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis. Journal of Neurology, 269(10), 5262-5271.
Moncharmont, P., Barday, G., & Benamara, H. (2020). Adverse transfusion reactions with neurological signs in transfused patients. Transfusion Clinique et Biologique, 27(2), 87-90.
Muresanu, D. F., Strilciuc, S., & Stan, A. (2019). Current drug treatment of acute ischemic stroke: challenges and opportunities. CNS drugs, 33, 841-847.
Nandi, S. (2020). Synthetic Platelet-like Particles for the Enhancement of Wound Healing Outcomes. North Carolina State University.
Olindo, S., Albucher, J. F., Bejot, Y., Berge, J., Cordonnier, C., Guillon, B., ... & Sibon, I. (2022). Tenecteplase in acute ischemic stroke: Review of the literature and expert consensus from the French Neurovascular Society. Revue Neurologique.
Putaala, J., Saver, J. L., Nour, M., Kleindorfer, D., McDermott, M., & Kaste, M. (2021). Should tenecteplase be given in clinical practice for acute ischemic stroke thrombolysis?. Stroke, 52(9), 3075-3080.
Psychogios, K., Palaiodimou, L., Katsanos, A. H., Magoufis, G., Safouris, A., Kargiotis, O., ... & Tsivgoulis, G. (2021). Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion. Therapeutic Advances in Neurological Disorders, 14, 1756286420986727.
Ratziu, V., De Guevara, L., Safadi, R., Poordad, F., Fuster, F., Flores-Figueroa, J., ... & Sanyal, A. J. (2021). Aramchol in patients with nonalcoholic steatohepatitis: a randomized, double-blind, placebo-controlled phase 2b trial. Nature Medicine, 27(10), 1825-1835.
Tanswell, P., Modi, N., Combs, D., & Danays, T. (2002). Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction. Clinical pharmacokinetics, 41, 1229-1245.
Thelengana, A., Radhakrishnan, D. M., Prasad, M., Kumar, A., & Prasad, K. (2019). Tenecteplase versus alteplase in acute ischemic stroke: systematic review and meta-analysis. Acta Neurologica Belgica, 119, 359-367.
Xu, N., Chen, Z., Zhao, C., Xue, T., Wu, X., Sun, X., & Wang, Z. (2018). Different doses of tenecteplase vs alteplase in thrombolysis therapy of acute ischemic stroke: evidence from randomized controlled trials. Drug Design, Development and Therapy, 2071-2084.
Yamamoto, A., Hattammaru, Y., & Uezono, S. (2020). Spontaneous intracranial hypotension associated with cerebral venous thrombosis detected by a sudden seizure: a case report. JA Clinical Reports, 6, 1-7.
Yu, W., Yin, N., Yang, Y., Xuan, C., Liu, X., Liu, W., ... & Shi, J. (2022). Rescuing ischemic stroke by biomimetic nanovesicles through accelerated thrombolysis and sequential ischemia-reperfusion protection. Acta Biomaterialia, 140, 625-640.