Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe - LARVOL DELTA

Efficacy and Safety of Recombinant Human Prourokinase in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. (PubMed, Brain Sci) - " IV rhPro-UK provides non-inferior efficacy to both alteplase and standard care with a better safety profile at 35 mg, while IA rhPro-UK enhances functional outcomes in middle cerebral artery occlusions, albeit with safety concerns. Further trials are needed to confirm long-term outcomes, optimal dosing, and broader applicability."

Journal • Retrospective data • Review • Cardiovascular • Hematological Disorders • Ischemic stroke

Use of alteplase continuous rate infusion, pentoxifylline, and cyproheptadine in association or not, in acute feline aortic thromboembolism: a study of nine cats. (PubMed, Front Vet Sci) - "No other outcome characteristics were different between survivors and non-survivors. rtPA CRI, PTX and/or CYP could be considered for treatment of FATE."

Journal • Acute Kidney Injury • Cardiovascular • Hematological Disorders • Nephrology • Renal Disease • Reperfusion Injury • Thrombosis

Unexpected Development of Pericardial Effusion in a Patient With Influenza and Secondary Bacterial Infection. (PubMed, Cureus) - "While a causal relationship cannot be definitively established, this temporal association raises concern for a potential, previously unreported complication. We present this case to raise clinical awareness of this life-threatening possibility and encourage its consideration in the differential diagnosis when managing similar patients."

Journal • Cardiovascular • Infectious Disease • Influenza • Respiratory Diseases

A Case of Tension Hydropneumothorax Secondary to Gastric Contents Following Hiatal Hernia Repair (ATS 2025) - "Her postoperative course was complicated by mediastinitis and empyema, managed with ampicillin/sulbactam, fluconazole, and intrapleural alteplase with dornase. Discussion Hydropneumothorax may arise after Type IV hiatal hernia repair due to anatomical and physiological disruptions from herniation, such as incarceration, ischemia-induced perforation, or subsequent interventions. This unique case, with a series of complications including recurrent repairs, gastric perforation, empyema, and partial gastrectomy with RYGB, underscores the need for provider vigilance and a high index of suspicion for postoperative complications."

Clinical • Anesthesia • Cardiovascular • CNS Disorders • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Psychiatry • Respiratory Diseases

The C.diff Is Lost: Polymicrobial Clostridioides Difficile Empyema (ATS 2025) - "The patient was started on ceftriaxone and azithromycin for presumed community acquired pneumonia...A chest tube was inserted, and the patient received three doses of intrapleural fibrinolysis with alteplase and dornase alfa due to the loculated nature of the empyema...The patient recovered well, the chest tube was removed, and he was discharged on a 4-week course of oral metronidazole...Immunocompromised patients, such as those with end-stage renal disease on hemodialysis, are at increased risk for complicated infections, including those caused by atypical organisms. This case emphasizes the importance of considering a broad differential diagnosis when evaluating infections in immunocompromised patients."

Cardiovascular • Congestive Heart Failure • Cough • Gastrointestinal Disorder • Heart Failure • Infectious Disease • Nephrology • Pneumonia • Renal Disease • Respiratory Diseases

Clearing the Air: Use of Intrapleural Fibrinolytics in a Case of Streptococcus Intermedius Empyema (ATS 2025) - "The patient received broad spectrum antibiotics with vancomycin, doxycycline and ampicillin-sulbactam. Combining accurate pathogen identification with effective treatments like alteplase can optimize management strategies and improve patient care in empyema cases. Despite the promising insights regarding the potential benefits of targeted treatments, more research is required to fully understand its clinical implications and optimize management strategies."

Clinical • Cardiovascular • Cough • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Infectious Disease • Respiratory Diseases

Ischemic Stroke, Infection, or Autoimmune? A Case Report Highlighting the Challenges to Diagnose Mogad "Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease" (ATS 2025) - "CT scan was negative, and the patient received alteplase for suspected ischemic stroke...Heightened clinical awareness and consideration of MOGAD in similar cases should guide medical management, especially with the challenges faced due to the limited availability of MOG-IgG testing. The ability to routinely test for MOG-IgG could potentially aid in early diagnosis and intervention, ultimately improving outcomes for patients with this complex and often elusive disorder."

Case report • Clinical • Absence Seizure Disorder • Cardiovascular • CNS Disorders • Epilepsy • Immunology • Infectious Disease • Ischemic stroke • Multiple Sclerosis • Neuromyelitis Optica Spectrum Disorder • Ocular Inflammation • Ophthalmology • Optic Neuritis • Pain • Rare Diseases • Solid Tumor

Unusual Case of Catatonia After Sedation With Propofol (ATS 2025) - "Neurology evaluated and advised clinical presentation was not consistent with stroke pattern so alteplase administration was deferred...Symptoms persisted for several days and she was admitted to psychiatry for treatment with lorazepam...She remained unresponsive for 30 minutes before returning to baseline, with no recall of the events after the operation. Our case emphasizes the importance of considering catatonia as a rare but potential reaction."

Clinical • Anesthesia • Cardiovascular • CNS Disorders • Coronary Artery Disease • Depression • Diabetes • Gastroenterology • Genito-urinary Cancer • Hypertension • Metabolic Disorders • Movement Disorders • Oncology • Parkinson's Disease • Prostate Cancer • Psychiatry • Solid Tumor • Ventricular Tachycardia

Orofacial Angioedema Following Tenecteplase Administration in an Acute Ischemic Stroke: A Case Report (ATS 2025) - "While intracerebral hemorrhage remains the most feared complication of thrombolytic agents such as alteplase and tenecteplase in the management of acute ischemic stroke, these agents have also been linked to the occurrence of orofacial angioedema...1), prompting the administration of diphenhydramine, famotidine, dexamethasone, and subcutaneous epinephrine...Unlike mast cell-mediated angioedema, bradykinin-mediated cases do not typically respond to standard treatments like epinephrine or antihistamines; instead, management includes bradykinin-targeting therapies such as icatibant or C1 inhibitor concentrates. FFP contains C1 esterase inhibitor proteins decreasing further bradykinin production and kininase II which breaks down bradykinin. Although studies on the efficacy of FFP are limited, it should be considered when bradykinin-targeting therapies are not available to treat tenecteplase-induced angioedema."

Case report • Clinical • Cardiovascular • Cerebral Hemorrhage • Chronic Kidney Disease • CNS Disorders • Coronary Artery Disease • Dermatology • Dyslipidemia • Hematological Disorders • Hypertension • Immunology • Ischemic stroke • Nephrology • Pain • Pruritus • Renal Disease • Urticaria

Concurrent Myocardial Infarction and Ischemic Stroke With Underlying Endocarditis (ATS 2025) - "He was started on epinephrine and norepinephrine drip with a transcutaneous cardiac pacing...The patient was started on aspirin, atorvastatin, and ticagrelor...Likewise, taking the patient for catheterization will delay the golden hour for IV Alteplase/Tenecteplase. In the case of our patient, we opted to take the patient for an emergent catheterization lab because he was hemodynamically and electrically unstable. Treatment should be personalized to each individual depending on the clinical scenario."

Cardiovascular • CNS Disorders • Coronary Artery Disease • Depression • Dyslipidemia • Hypertension • Infectious Disease • Ischemic stroke • Myocardial Infarction • Pain • Psychiatry • Septic Shock • Thrombosis

Using a Pigtail Catheter as an 'Empyema-tube' in the Day and Age of Intrapleural Fibrinolytic Therapy (IPFT) and Video-assisted Thoracoscopic Surgery (VATS) (ATS 2025) - "There was inadequate pleural fluid drainage despite flushing the tube with saline and a 3-day trial of intrapleural alteplase and dornase...Thus, in summary, tailoring IPFT to patient profiles and timely surgical referral based on clinical presentation is of utmost importance. In nonsurgical patients, as in our case, a multidisciplinary approach with pulmonary and thoracic surgery is necessary to develop a comprehensive treatment plan, facilitate early hospital discharge and reduce morbidity."

Surgery • Video • Chronic Lymphocytic Leukemia • Dermatology • Hematological Malignancies • Lymphoma • Oncology • Pulmonary Disease • Respiratory Diseases

Persistent Complicated Pleural Effusion From "Occult" Boerhaave's Syndrome (ATS 2025) - "Repeat cultures grew Candida glabrata and tropicalis resistant to fluconazole. Patient improved after micafungin, second chest tube, and alteplase-dornase for multi-septated effusion...Repeat cultures grew vancomycin-resistant Enterococcus faecium...Boerhaave syndrome still represents a significant diagnostic and therapeutic challenge, particularly with nonspecific symptomatology and absence of classic findings. High index of suspicion is required, and early surgical intervention remains critical."

Pleural effusion • Fibrosis • Gastrointestinal Disorder • Hepatology • Immunology • Infectious Disease • Pain • Pulmonary Disease • Respiratory Diseases

Beyond Pulmonary Embolism: When the Clot Thickens (ATS 2025) - "He received 50 mg alteplase followed by heparin infusion with improvement in tachycardia and right ventricular function...Summary: Although mediastinal vascular tumors are rare, it is important to maintain a high index of suspicion given the significant morbidity and mortality associated with the disease. Furthermore, this case highlights the importance of a multidisciplinary approach for diagnosis and the consideration for EBUS-TBNA as a minimally invasive and safe diagnostic modality in appropriate cases."

Angiosarcoma • Cardiovascular • Heart Failure • Infectious Disease • Oncology • Pneumonia • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Sarcoma • Solid Tumor

Production and Characterization of Double-membrane Echogenic Liposomal Carrier-loaded Alteplase for Thrombolytic Treatment of Empyema (ATS 2025) - "DM-TELIP may represent a novel adjunct for fibrinolytic therapy that encapsulates more sctPA than previous TELIP formulations. The efficacy of DM-Val-TELIP alone and in combination with transthoracic ultrasound to release the internalized product will now be tested in a rabbit model of an acute infectious pleural injury."

Infectious Disease • Pneumonia

Thrombolysis for Pulmonary Embolism - Patience Is a Virtue (ATS 2025) - "He was consented and thrombolysed with alteplase and subsequently prescribed intravenous heparin. Discussion In patients who have significant PE burden with preserved systemic BP and stable HR and SaO2, and who by initial criteria would not necessarily be candidates for thrombolytic therapy, assessment of haemodynamic compromise to define candidacy for thrombolysis should include prospective clinical and echocardiographic assessment in conjunction with CTPA. The decision of whether to thrombolyse these patients should not be made on assessment of blood pressure, heart rate and SaO2 alone."

Cardiovascular • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Successful Recovery Despite 130 Minutes of Prolonged and Recurrent Pulseless Electrical Activity Caused by Massive Pulmonary Embolism Due to Popliteal Venous Aneurysm (ATS 2025) - "Finally, after 14 attempts over 130 minutes of CPR and 23-doses of 1 mg intravenous epinephrine, ROSC was achieved...He was highly suspected of having PE, and we decided to conduct rescue thrombolysis using a 6 mg bolus dose of alteplase followed by a 54 mg infusion over one hour...Once the patient's PVA was confirmed, we were able to promptly insert an IVC filter and ultimately correct the problem surgically. The patient recovered completely through this treatment and was able to return to his daily life."

Cardiovascular • Hematological Disorders • Hypertension • Inflammation • Mood Disorders • Pain • Pulmonary Embolism • Respiratory Diseases

Rescue Therapy With Tenecteplase for Massive Pulmonary Embolism: A Case Report (ATS 2025) - "He also required dobutamine drip for inotropic support in the setting of right ventricle failure. Tenecteplase is primarily used to treat myocardial infarction and ischemic stroke, offering advantages such as easier administration and a more favorable pharmacokinetic profile compared to other systemic thrombolytics like alteplase. Recent studies suggest that Tenecteplase may improve survival rates in patients with high-risk pulmonary embolism. This case underscores the potential of TNK as an effective alternative thrombolytic therapy in managing acute PE, especially in hemodynamically unstable patients."

Case report • Clinical • Cardiovascular • Hypotension • Ischemic stroke • Myocardial Infarction • Pulmonary Embolism • Respiratory Diseases

Case Series of Cocaine-induced Pulmonary Embolism: An Unexpected Association or Emerging Trend? (ATS 2025) - "She improved after treatment with alteplase and heparin. Case 2: A 27-year-old male with polysubstance abuse and previous DVT on an IVC filter for 3 years, presented with shortness of breath, diagnosed with PE in the right lateral basal segment; he was discharged on rivaroxaban following enoxaparin treatment...This case series adds to limited research on cocaine-induced PE, suggesting it may represent an emerging trend. Increased clinical awareness and further research into the mechanisms and management of cocaine-induced PE could improve outcomes for this patient population."

Clinical • Cardiovascular • CNS Disorders • Depression • Genetic Disorders • Major Depressive Disorder • Mood Disorders • Obesity • Pain • Psychiatry • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Atraumatic Right Sided Colo-pleural Fistula After Transcatheter Arterial Chemoembolization (ATS 2025) - "A pigtail catheter was placed which drained 1700cc of exudative fluid with cultures growing Enterococcus Gallinarum sensitive to ampicillin. Over the next day, drainage from chest tube slowed despite administration of alteplase and dornase...Right sided colopleural fistulas are rare given the natural diaphragmatic border formed by the liver, however they confer high mortality. As such, high suspicion is needed in patients who have enteric flora present in pleural fluid."

Barrett Esophagus • Diabetes • Fibrosis • Gastroenterology • Gastrointestinal Cancer • Gastrointestinal Disorder • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Inflammatory Bowel Disease • Metabolic Disorders • Mood Disorders • Oncology • Respiratory Diseases • Septic Shock • Solid Tumor

Tuberculosis Pleuritis Treated With Intrapleural Lytics Complicated by Recurrence Requiring Video-assisted Thorascopic Surgery (ATS 2025) - "Subsequently, they were treated with six doses of alteplase and dornase installations into the pleural cavity over three days...Interestingly, the area of concern on imaging was not consistent with previously assumed fluid and instead was a thickened granulomatous peel. This development further mystifies if intrapleural lytic therapy is appropriate in the management of complicated tuberculosis pleuritis or if it leads to increased complications compared to standard therapy."

Surgery • Video • Infectious Disease • Musculoskeletal Pain • Pain • Respiratory Diseases • Tuberculosis

Rapid Development of Plastic Bronchitis in a Child With a Fenestrated Fontan (ATS 2025) - "He was admitted on humidified heated high-flow nasal cannula with FiO2 21-25% and treated with antiviral therapy, steroids, antibiotics, and inhaled alteplase with albuterol and vest therapy...A growing body of literature suggests that the problematic lymphatic changes collectively referred to as "pulmonary lymphatic perfusion syndrome" take place much earlier in Fontan patients than previously appreciated and may be related to underlying anatomic anomalies exacerbated by single ventricle physiology. This warrants discussion on whether lymphatic studies should be obtained prior to Fontan procedures to understand the risk of complications post-procedurally."

Clinical • Asthma • Cardiovascular • Cough • Immunology • Infectious Disease • Novel Coronavirus Disease • Pediatrics • Pneumonia • Pulmonary Disease • Respiratory Diseases

Dissolving porcine and human microthrombi by short exposure to microdoses of alteplase in an in vitro model of microvascular obstruction. (PubMed, Sci Rep) - "The combination of short drug exposure and high local concentration is possible with a recently developed infusion system based on intracoronary controlled flow infusion (CoFI). CoFI uses microdoses of alteplase that are up to 1300 times lower than intravenous doses and could thereby minimize bleeding risk."

Journal • Preclinical • Cardiovascular • Myocardial Infarction

Arterial collateral status and treatment effect of intravenous alteplase thrombolysis prior to endovascular treatment in patients with anterior circulation large vessel occlusion: prespecified analysis of the MR CLEAN-NO IV trial. (PubMed, J Neurointerv Surg) - "In the MR CLEAN-NO IV trial, we did not find evidence that arterial collateral status measured with a visual score or quantitative score can inform treatment decisions regarding IVT plus EVT for patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation within 4.5 hours."

Journal • Cardiovascular • Ischemic stroke

Intra-arterial Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP) (clinicaltrials.gov) - P=N/A | N=376 | Recruiting | Sponsor: Xuanwu Hospital, Beijing | Trial completion date: Jul 2026 ➔ Sep 2025 | Trial primary completion date: Jul 2025 ➔ Mar 2025

Trial completion date • Trial primary completion date • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombosis

Fibrinogen Depletion Coagulopathy and Hemorrhagic Transformation in Acute Ischemic Stroke Treated With Bridging Therapy. (PubMed, Stroke) - "None of the 26 patients who received tenecteplase experienced FDC, compared with 53 of 135 (39.3%) patients treated with alteplase (P<0.01). Following bridging therapy, FDC is a frequent event associated with increased risks of any HT, symptomatic HT, parenchymal hematomas, and 3-month mortality. FDC did not occur following IVT with tenecteplase in our cohort, suggesting that the fibrin specificity of thrombolytic agents may play a pivotal role in its development."

Journal • Cardiovascular • Hematological Disorders • Ischemic stroke