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

Optimal Timing of Post-Alteplase Brain Computed Tomography: Routine Twenty-Four-Hour Versus Extended Forty-Eight-Hour for Detecting Asymptomatic Intracranial Hemorrhage. (PubMed, J Clin Med Res) - "CT imaging at 48 h post-alteplase improves asICH detection compared with the 24-h scan, reducing missed cases without added radiation or resource burden. Multicenter validation is needed to confirm whether 48 h should replace the current standard."

Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Functional Ultrasound Imaging Uncovers Vascular Connectivity and Dynamics in Awake Mice During Hyperacute Stroke Phase. (PubMed, Stroke) - "Twenty minutes postocclusion, mice received intravenous rtPA (recombinant tissue-type plasminogen activator; Alteplase, 10 mg/kg; 10% bolus/90% infusion over 40 minutes, n=31) or saline (n=29)...Awake thromboembolic stroke model with early functional ultrasound imaging completed with magnetic resonance imaging uncovers rapid blood flow perturbations and connectivity disruptions that are sensitive to rtPA and predictive of final lesion outcome. This platform enhances translational relevance by enabling hypothesis-testing of novel thrombolytics under physiologically intact conditions."

Journal • Preclinical • Anesthesia • Cardiovascular • Ischemic stroke • PLAAT3

Case report: Can fibrinolytics effectively manage gross hematuria and clot retention in an elderly patients, leading to the diagnosis of lymphoma? (PubMed, Urol Case Rep) - "Bilateral nephrostomies with multiple Alteplase instillations dissolved clots, restored urinary flow, and normalized renal function. Bone marrow biopsy confirmed B-cell lymphoma. This case highlights fibrinolytic therapy as a minimally invasive option for clot retention and the importance of multidisciplinary evaluation in uncovering malignancies presenting with complex urologic emergencies."

Journal • B Cell Lymphoma • Hematological Disorders • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology

Diagnostic Challenge of Tuberculous Pleural Effusion: Elevated Adenosine Deaminase (ADA) as the Key Indicator in the Absence of Microbiological Confirmation. (PubMed, Cureus) - "The course was complicated by respiratory failure requiring intubation, surgical tracheostomy, video-assisted thoracoscopic surgery (VATS) decortication with talc pleurodesis, ventilator-associated pneumonia due to Pseudomonas aeruginosa, and only partial response to intrapleural alteplase for persistent loculations...He was discharged clinically stable after 117 days of hospitalization (on day 52 of anti-TB therapy). In high probability scenarios with lymphocytic exudate with high ADA and compatible clinical features, empirical anti-TB therapy can be justified despite repeatedly negative microbiology, particularly when alternative diagnoses are excluded and the patient fails to respond to appropriate antibiotics."

Journal • Pleural effusion • Hodgkin Lymphoma • Infectious Disease • Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases • Tuberculosis

Low-dose vs. standard-dose alteplase for acute ischemic stroke: a real-world single-center retrospective study. (PubMed, Front Neurol) - "Low-dose alteplase demonstrated similar clinical outcomes to standard-dose alteplase in this real-world setting. Future research should focus on optimizing treatment decisions and improving guideline adherence to enhance patient outcomes."

Journal • Real-world evidence • Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Comparison of Door to Needle Times for Three Fibrinolytic Strategies in Acute Ischemic Stroke. (PubMed, Hosp Pharm) - "Alteplase remains the guideline-directed fibrinolytic of choice for acute ischemic stroke (AIS), however, tenecteplase has grown in popularity as new data have emerged. This project highlighted the potential effects of having more than one fibrinolytic agent on formulary for acute ischemic stroke with different criteria for use. DTN time was not prolonged with two fibrinolytics on formulary."

Journal • Cardiovascular • Ischemic stroke

Intracoronary Low-Dose Recombinant Tissue Plasminogen Activator in Primary PCI for ST-Segment Elevation Myocardial Infarction and Large Thrombus Burden: A Randomized Trial. (PubMed, J Am Coll Cardiol) - P3 | "Among patients undergoing primary PCI for STEMI and large thrombus burden, intracoronary administration of alteplase was not superior to placebo in reducing the composite primary outcome of MACE at 30 days, MBG 0/1, distal embolization or failure to achieve ≥ 50% ST-segment resolution. These data do not support the routine administration of this therapy in patients with STEMI undergoing primary PCI. (clinicaltrials.gov NCT03335839)."

Clinical • Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Myocardial Infarction • Thrombosis

Intralesional Alteplase as an Adjunct to Percutaneous Drainage for a Large Iliopsoas Muscle Hematoma in a Patient With Von Willebrand Disease: A Case Report. (PubMed, Cureus) - "The patient was discharged with minimal residual weakness, and at six weeks, imaging showed near-complete resolution of the collection and full return to daily activities. This case demonstrates the success of combining percutaneous drainage with fibrinolytic agents as an effective and safe alternative to conventional surgical management in patients with severe coagulopathies."

Journal • Hemophilia • Pain

Factors affecting the early efficacy of intravenous thrombolysis using alteplase in acute ischemic stroke: A retrospective analysis of 255 cases. (PubMed, Medicine (Baltimore)) - "Male gender, drinking history, baseline NIHSS score, OTT, and rtPA dose are independent factors affecting early thrombolysis efficacy. Age, AF history, high FIB level, and high SBP may also be potential risk factors."

Journal • Observational data • Retrospective data • Cardiovascular • Ischemic stroke

Behçet's Disease Presenting With Large Intracavitary Thrombi and Pulmonary Embolism. (PubMed, Cureus) - "Despite hemodynamic stability, the significant thrombus burden and presence of right ventricular thrombus prompted thrombolysis with intravenous Alteplase, resulting in clinical improvement, followed by anticoagulation therapy. Further workup, including HLA-B51 testing and the presence of recurrent folliculitis, supported a diagnosis of Behcet's disease. This report emphasizes the importance of early recognition and combined immunosuppressive and anticoagulant therapy to manage this rare but fatal presentation."

Journal • Cardiovascular • Immunology • Inflammation • Musculoskeletal Diseases • Pulmonary Embolism • Rare Diseases • Respiratory Diseases • Thrombosis

Safety and Efficacy of Intravenous Tenecteplase Prior to Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis (AHA 2025) - "Tenecteplase (TNK), a genetically modified variant of alteplase with greater fibrin specificity and a longer half-life, allows single-bolus administration, offering practical and pharmacological advantages. This meta-analysis of five clinical trials suggests that intravenous tenecteplase prior to mechanical thrombectomy is associated with favorable reperfusion and functional outcomes in patients with LVO stroke. However, the elevated risk of intracranial hemorrhage findings supports the importance of careful patient selection. These findings support the continued investigation of TNK in randomized controlled trials to further define its safety and efficacy profile in acute stroke care."

Retrospective data • Review • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

A Hidden Threat: Trazodone-Induced Warfarin Failure Leading to Acute Mechanical Aortic Valve Thrombosis (AHA 2025) - "Due to prohibitive surgical risk, thrombolysis with alteplase (25 mg over 6 hours) was administered...He was stabilized on milrinone and extubated by hospital day five.Despite restarting warfarin—at doses up to 30 mg daily (three times his prior regimen)—therapeutic INR was not achieved until 10 days later...While the exact mechanism is unclear, proposed theories include CYP2C9 induction, increased warfarin clearance, or protein-binding displacement. This case highlights the need for close INR monitoring when initiating trazodone in patients on warfarin."

Acute Respiratory Distress Syndrome • Back Pain • Cardiovascular • Cough • Hematological Disorders • Hepatology • Infectious Disease • Liver Failure • Musculoskeletal Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases • Septic Shock • Thrombosis • CYP2C9

Heparin-Resistant Massive Pulmonary Embolism in a Young Female: A Multi-Hit Thrombotic Storm (AHA 2025) - "Immediate anticoagulation with heparin was initiated, followed by ICU admission where alteplase was administered for massive PE. Remarkably, the patient demonstrated complete heparin resistance with no APTT response despite escalating doses over 24 hours and the decision was made to switch to rivaroxaban 15mg twice daily...This case demonstrates how multiple thrombotic risk factors can synergistically create catastrophic pulmonary embolism in young patients. Early recognition and aggressive intervention with thrombolysis can be life-saving. The identification of heparin resistance as a clinical clue to underlying thrombophilia opens new diagnostic pathways for personalized anticoagulation strategies, potentially revolutionizing PE management in the era of precision medicine."

Cardiovascular • Hematological Disorders • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Lytics or Leave it? Prosthetic Valve Thrombosis with Severe Aortic Insufficiency (AHA 2025) - "Description of case: A 39-year-old man with history of unicuspid aortic valve status-post bicuspidization (2017), subsequent severe aortic insufficiency prompting mechanical aortic valve replacement (2023), recent prosthetic valve thrombosis on therapeutic warfarin complicated by stenosis and shock prompting redo mechanical aortic valve replacement (2/2025, 23mm On-X), presented with acute dyspnea, chest pain, and loss of mechanical click.He was found to have SCAI-C cardiogenic shock, with exam notable for III/VI systolic crescendo-decrescendo and IV/IV decrescendo early diastolic murmurs, and absent mechanical click...Valve fluoroscopy showed minimal movement of both discs suggesting thrombosis.The patient was deemed high risk for surgical intervention and therefore received systemic thrombolysis with alteplase 25mg over 6h x2...Eosinophilia peaked at 16.7 K/cu mm and normalized with high-dose prednisone...Few cases have been reported of eosinophilia-driven prosthetic..."

Cardiovascular • Eosinophilia • Eosinophilic Granulomatosis With Polyangiitis • Hematological Disorders • Immunology • Inflammation • Langerhans Cell Histiocytosis • Pulmonary Disease • Thrombosis

Right Atrial Perforation and Cardiac Tamponade: A Rare Complication of Femoral Hemodialysis Catheter Exchange (AHA 2025) - "After unsuccessful local alteplase, interventional radiology performed a left femoral hemodialysis catheter exchange... This case highlights the need for vigilance for mechanical complications, even with femoral central venous access. Immediate bedside echocardiography was critical for rapid diagnosis and intervention. The patient made a complete recovery following pericardiocentesis and was discharged asymptomatic on hospital day four."

Breast Cancer • Congestive Heart Failure • Heart Failure • Hypotension • Nephrology • Renal Disease • Solid Tumor

An Updated Meta-analysis of Extended Thrombolytic Treatment Windows for Acute Ischemic Stroke (AHA 2025) - "Subgroup analysis compared alteplase and tenecteplase (TNK). Eleven RCTs with 3,425 patients (mean age 69.5 years; 58.9% male) were included, with 1,737 receiving IVT and 1,688 on standard care. In AIS patients treated 4.5–24 hours post-LKW, IVT improved functional outcomes compared to standard care despite higher sICH risk. TNK appeared non-inferior to alteplase. Further RCTs are needed to refine late-window thrombolysis."

Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Thrombolysis for Minor Non-Disabling Ischemic Stroke: A Meta-analysis of Randomized Controlled Trials (AHA 2025) - "Three trials used alteplase (PRISMS, ARAMIS, MINOR), one tenecteplase (TEMPO-2), and one prourokinase (PUMICE). In patients with minor non-disabling ischemic stroke, thrombolysis was associated with significantly worse clinical outcomes, including reduced functional recovery, higher risk of sICH, and increased mortality. These findings argue against the routine use of thrombolysis in this patient population."

Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Multiparametric Contrast-Free MRI Successfully Identifies Venous Thrombus Responsive to Lytic Therapy: From Mice to Humans. (PubMed, Circ Cardiovasc Imaging) - "Venous thrombosis was induced in the inferior vena cava of BALB/C mice (n=56, male), which were imaged up to 28 days postsurgery and 24 hours after systemic thrombolysis (Actilyse, 10 mg/kg, IV)...MSTI enables noninvasive, contrast-free characterization of thrombus composition and predicts thrombolytic susceptibility. This technique has the potential to guide patient selection for invasive therapies and should be incorporated into future trials of venous thrombosis treatment."

Journal • Preclinical • Cardiovascular • Hematological Disorders • Thrombosis

Hepatic Candidiasis in a Patient With ANCA-Associated Vasculitis Following Immunosuppressant-Induced Neutropenia (ACG 2025) - "Azathioprine had been discontinued 5 months earlier due to neutropenic fever; she remained on prednisone...Residual fluid was treated with intralesional Dornase and Alteplase...In our patient, prompt oral fluconazole and adjunctive intralesional fibrinolytics led to full recovery. This case highlights the importance of early recognition, appropriate antifungal therapy, and multidisciplinary management for optimal outcomes.Figure: Figure 1. Axial CT showing subcapsular perihepatic fluid collection (~164 × 120 mm) consistent with hepatic abscess.Figure: Figure 2: Endoscopic view during ERCP showing extraction of a large clot, sludge, and stone fragments from the biliary duct."

Clinical • Acute Respiratory Distress Syndrome • ANCA Vasculitis • Candidiasis • Febrile Neutropenia • Gastroenterology • Glomerulonephritis • Hematological Malignancies • Hepatology • Immunology • Infectious Disease • Lupus Nephritis • Nephrology • Neutropenia • Pneumonia • Vasculitis

Unusual consequences of intravenous thrombolysis in a patient undergoing delayed aortic surgery for aortic dissection presenting as acute ischemic stroke: a case report. (PubMed, BMC Cardiovasc Disord) - No abstract available

Journal • Cardiovascular • Ischemic stroke

A multicenter, prospective, randomized, open-label, blinded endpoint trial of intravenous thrombolysis with tenecteplase for acute non-large vessel occlusion in extended time window (OPTION): Rationale and design. (PubMed, J Transl Int Med) - P4 | "Recombinant human tenecteplase (TNK) tissue-type plasminogen activator (rhTNK-tPA, also named tenecteplase) is non-inferior to alteplase when given up to 4.5 hours after acute ischemic stroke (AIS) within 4.5 hours. Safety outcomes include symptomatic intracranial hemorrhage within 36 hours, systemic bleeding within 90 days, and mortality within 90 days. The OPTION trial (NCT05752916) will provide evidence regarding the efficacy and safety of tenecteplase 4.5 to 24 hours in patients with AIS due to non-LVO."

Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Dual Radial and Femoral Arterial Access for Mechanical Thrombectomy in Acute Middle Cerebral Artery Occlusion: A Case Report. (PubMed, Am J Case Rep) - "Intravenous alteplase was administered but was ineffective...This hybrid approach, employing a "snare-grasp-fix-guide" strategy, successfully navigated complex anatomy that impeded standard femoral access alone. It underscores the importance of adaptable, individualized access strategies and the potential of combined approaches to optimize device delivery and improve outcomes in challenging neurointerventional procedures."

Journal • Cardiovascular • Ischemic stroke

COMPARATIVE ANALYSIS OF TENECTEPLASE AND ALTEPLASE FOR INTRAVENOUS THROMBOLYSIS ACUTE ISCHEMIC STROKE MANAGEMENT ACROSS A STROKE NETWORK IN BOGOTÁ, COLOMBIA, FROM 2023 TO 2024. (WSC 2025) - "TNK showed no significant differences in functional independence or symptomatic hemorrhage compared to alteplase, but was associated with increased mortality risk. However, the association lost statistical significance when patients treated with thrombolysis after the 4.5-hour window were excluded. Further research is needed to guide clinical and public health strategies."

Cardiovascular • Hematological Disorders • Ischemic stroke

PROLONGED LOW-DOSE INTRAVENOUS THROMBOLYSIS IN EARLY RECURRENT STROKE: ESR-PROLONG STUDY (WSC 2025) - "We present the results of a multicenter retrospective study using prolonged low-dose intravenous thrombolysis. The multicenter retrospective study ESR_PROLONG (2020-2024) included consecutive patients who were given intravenous thrombolysis (20 mg alteplase continuously for 10 hours) during an early (within hours after standard recanalization therapy) recurrence of ischemic stroke... Rescue therapy in the form of prolonged low-dose thrombolysis seems to be an effective and safe alternative to therapeutic nihilism in ultra-early stroke recurrence. Data from a randomized trial would significantly contribute to confirming the results. Supported by the grant Krajská zdravotní a.s. IGA-KZ-2022-1-5"

Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

FUNCTIONAL AND SAFETY COMPARISON OF TENECTEPLASE VS. ALTEPLASE IN ACUTE ISCHEMIC STROKE: REAL-WORLD EVIDENCE FROM A SECONDARY-LEVEL MEXICAN HOSPITAL (WSC 2025) - "Tenecteplase demonstrated similar safety and functional outcomes compared to alteplase in patients with AIS treated within the therapeutic window. These findings support the clinical equivalence of both agents in real-world hospital settings"

Clinical • HEOR • Real-world • Real-world evidence • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Diabetes • Hematological Disorders • Hypertension • Ischemic stroke • Metabolic Disorders