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

The efficacy and safety of tenecteplase versus alteplase in patients with myocardial infarction: a systematic review (ESC-WCC 2025) - "Our study demonstrates Tenecteplase to be more efficacious and safer than Alteplase suggesting the use of Tenecteplase in clinical practice. However, it also raises the question of age-sex-ethnicity-bodyweight variability on the efficacy and safety of these two drugs suggesting Randomized Control Trials to answer this question."

Clinical • Review • Cardiovascular • Myocardial Infarction

Cigarette smoking and release of the inflammatory chemokine CXCL10 (IP-10) after ST-elevation myocardial infarction (ESC-WCC 2025) - " We measured serum CXCL10 level in archived blood samples from 354 patients with STEMI, who were enrolled in A Trial of Low-Dose Adjunctive Alteplase During Primary PCI (T-TIME)... In STEMI patients, current smoking is associated with markedly lower circulating levels of CXCL10, an inflammatory chemokine. In HCAECs, cigarette smoke extract treatment suppressed CXCL10 gene expression, supporting a direct mechanistic association. At 3 months after STEMI, lower CXCL10 level was associated with a reduced incidence of MACE."

Cardiovascular • Congestive Heart Failure • Dyslipidemia • Heart Failure • Hypertension • Myocardial Infarction • CXCL10

Percutaneous large-bore aspiration embolectomy with veno-arterial extracorporal membrane oxygenation (ECMO) support or standby for acute high-risk pulmonary embolism (ESC-WCC 2025) - "A bolus of alteplase was administered before hospital transfer or admission to 8 (18%) patients (Table)... Percutaneous large-bore aspiration embolectomy with VA-ECMO support or standby is feasible across the spectrum of high-risk PE. Initial PE severity correlates with mortality and hemodynamic decompensation. VA-ECMO upgrade was needed in a substantial proportion of patients and appears a reasonable strategy to prevent periprocedural death in patients with high-risk PE."

Cardiovascular • Pulmonary Embolism

Group 5: beyond the norm: exploring unique profiles of high-risk PE, including the role of the mechanical circulatory system (ERS 2025) - "Learning objectives: a. Absolute and relative CI of tPA: pros and cons of tPA, including Alteplase vs Tenecteplase. c. Role of ECMO as a bridge to Sx or Percutaneous embolectomy."

Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Standard treatment regimen with and without dexamethasone on outcome of children aged 3-7 years with empyema: a randomized double blind clinical trial. (PubMed, Ital J Pediatr) - "Our findings showed that the use of dexamethasone decreases the duration of hospitalization, duration of fever, and CRP levels, leading to faster recovery in children with empyema. Dexamethasone can be a safe and effective adjunctive therapy for empyema in children."

Journal • Infectious Disease • Influenza • Novel Coronavirus Disease • Pediatrics • Pneumonia • Respiratory Diseases • CRP

Efficacy and Safety Study of Proposed Biosimilar Product Reveliza vs Actilise in Patients With ST-segment Elevation Myocardial Infarction (clinicaltrials.gov) - P3 | N=180 | Completed | Sponsor: AO GENERIUM

New P3 trial • Cardiovascular • Myocardial Infarction

Associations between Fluid-Attenuated Inversion Recovery vessel hyperintensities and Alberta Stroke Programme Early CT Score and clinical outcomes in stroke patients with unknown time of onset: a sub-analysis from a randomized controlled trial. (PubMed, Int J Stroke) - "We estimated the correlation between FVH-ASPECTS and clinical outcomes in patients with wake-up stroke or unknown time of stroke onset.MethodsThe THrombolysis for Acute Wake-up and Unclear-onset Strokes with Alteplase at 0.6 mg/kg (THAWS) trial was a multicenter, randomized controlled trial conducted at 40 sites in Japan between 2014 and 2018...ROC analysis identified FVH-ASPECTS 3 or more as predictive of favorable outcomes (sensitivity 80%, specificity 51%, AUC 0.717). A significant correlation was observed between FVH-ASPECTS 3 or more and favorable outcomes (adjusted OR 4.50, 95% CI 1.89-10.75; p<0.001).ConclusionsFVH-ASPECTS could offer an indicator for achieving favorable clinical outcomes among stroke patients with unknown time of onset, with a threshold of 3 or more."

Clinical data • Journal • Cardiovascular • Ischemic stroke

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

Tenecteplase in Acute Ischemic Stroke: A Scientific Statement From the Korean Stroke Society. (PubMed, J Clin Neurol) - "These statements are intended to support the adoption of TNK in countries where it is not yet available, including South Korea, by providing up-to-date clinical evidence. Their implementation may broaden the therapeutic options for AIS patients and help align acute stroke care practices with international standards."

Journal • Cardiovascular • Ischemic stroke

A clinical case of treating a patient with severe ischemic stroke and cancer (PubMed, Zh Nevrol Psikhiatr Im S S Korsakova) - "Despite the high risk of hemorrhagic complications associated with underlying malignancy, systemic thrombolysis with alteplase was successfully administered; however, hemorrhagic transformation subsequently occurred. Early comprehensive rehabilitation and adjunctive therapy with Cerebrolysin (30 ml/day) significantly reduced neurological deficits. One month after the stroke, the patient exhibited near-complete motor recovery and substantial improvement in speech function without complications during anticoagulant therapy with apixaban. This case highlights the importance of early diagnosis and an integrated approach to the management of stroke in oncological patents."

Journal • Cardiovascular • Colon Cancer • Colorectal Cancer • Hematological Disorders • Ischemic stroke • Oncology • Solid Tumor • Thrombosis

SUCCESSFUL MANAGEMENT OF COMPLICATED TUBERCULOUS PLEURAL EFFUSION WITH NON-EXPANDABLE LUNG USING INTRAPLEURAL FIBRINOLYTIC AND ENZYME THERAPY (MTS 2025) - "Sequential IPFE therapy was administered every 12 hours, consisting of three doses of alteplase (5 mg) and dornase alfa (5 mg) with a dwell time of 45 minutes...While surgical intervention is often considered, IPFE therapy offers a minimally invasive alternative to enhance drainage and improve lung expansion. This case highlights the efficacy of IPFE in resolving a complex TB pleural effusion, reducing the need for more invasive procedures."

Pleural effusion • Cough • Infectious Disease • Inflammation • Pulmonary Disease • Respiratory Diseases • Tuberculosis

ENZYMATIC STABILITY OF CRYOPRESERVATION RT-PA IN PLEURAL INFECTION (MTS 2025) - "The pleural collection was drained, and intravenous Amoxicillin-Clavulanic Acid was initiated. In our case, cryofreeze Alteplase usage in our case showed significant clinical and radiological improvement. However more clinical studies needed to look into reliability of cryofreeze rt-PA and its cost effectiveness."

Cardiovascular • Cough • Hypertension • Infectious Disease • Respiratory Diseases

A NOVEL, COST-EFFECTIVE INTRAPLEURAL FIBRINOLYTIC REGIMEN: ALTEPLASE-TACHOLIQUINE PREVENTS SURGICAL REFERRAL IN 90% OF COMPLEX PLEURAL EFFUSIONS - A PILOT STUDY (MTS 2025) - "Our protocol addresses systemic barriers to care in Malaysia and provides a template for national scale-up. Prospective trials are planned to refine dosing."

Clinical • Cost effectiveness • HEOR • Pleural effusion • Infectious Disease • Respiratory Diseases • Tuberculosis

Bradykinin-Mediated Angioedema Induced by Drugs. (PubMed, J Clin Med) - "Specific approved drugs and a structured diagnostic workflow are unmet needs and are required for the management of this kind of AE. The aim of this review is to provide physicians with accurate knowledge of potentially life-threatening drug reactions so that they can be better understood and managed."

Journal • Review • Cardiovascular • Complement-mediated Rare Disorders • Hereditary Angioedema

Glenzocimab for reperfusion in the setting of endovascular therapy for brain infarction: GREEN study. (PubMed, J Neurointerv Surg) - P2/3 | "This is the first randomized trial evaluating the efficacy of glenzocimab with EVT. This prospective trial aims to determine whether glenzocimab with EVT improves functional outcome."

Journal • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombosis

Transforming pulmonary embolism care: advanced catheter techniques in Pakistan: a case report. (PubMed, J Pak Med Assoc) - "Catheter-directed thrombolysis (CDT) was initiated, administering alteplase at 1 mg/hour per catheter. She was discharged on rivaroxaban and resumed normal activities within one week. This case underscores the efficacy of CDT as a life-saving alternative in high-risk post-operative PE, especially in resourceconstrained settings."

Journal • Cardiovascular • Gynecology • Pain • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Early percutaneous thrombolysis for AVF thrombosis: symptom duration as a predictor of endovascular salvage. (PubMed, CVIR Endovasc) - "Percutaneous thrombolytic therapy is a highly effective and minimally invasive option for acute AVF thrombosis. Symptom duration > 2.5 days is a key threshold predicting the need for EVT, highlighting the critical importance of early intervention. These findings may inform clinical decision-making and optimize access salvage strategies in dialysis patients."

Journal • Cardiovascular • Hematological Disorders • Thrombosis

Adjunctive Thrombolytics After Successful Endovascular Reperfusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. (PubMed, Ann Neurol) - "IAT following successful EVT significantly enhances the likelihood of achieving an excellent functional outcome, particularly in anterior circulation strokes. Although the benefit in posterior circulation strokes remains uncertain, the lack of significant differences in sICH risk and mortality across thrombolytic drugs and stroke locations support the safety of IAT. ANN NEUROL 2025."

Journal • Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

FIVHeMA: Intraventricular Fibrinolysis for Aneurysmal Subarachnoid Hemorrhage. (clinicaltrials.gov) - P3 | N=81 | Terminated | Sponsor: University Hospital, Caen | N=440 ➔ 81 | Trial completion date: Mar 2024 ➔ Feb 2025 | Suspended ➔ Terminated; lack of patient

Enrollment change • Trial completion date • Trial termination • Cardiovascular • Hematological Disorders • Subarachnoid Hemorrhage

Latent Cytomegalovirus Infection Is Associated With Impaired Left Ventricular Function After ST-Segment-Elevation Myocardial Infarction. (PubMed, J Am Heart Assoc) - "Patients who are cytomegalovirus-positive with STEMI have impaired reperfusion, reduced left ventricular function, and less improvement in health-related quality of life over 3 months."

Journal • Cardiovascular • Congestive Heart Failure • Cytomegalovirus Infection • Heart Failure • Infectious Disease • Inflammation • Myocardial Infarction

Vitrectomy, Subretinal Tissue Plasminogen Activator (TPA) and Intravitreal Gas for Submacular Haemorrhage Secondary to Exudative (Wet) Age-related Macular Degeneration (TIGER). (clinicaltrials.gov) - P3 | N=210 | Recruiting | Sponsor: King's College Hospital NHS Trust | Trial completion date: Dec 2025 ➔ Dec 2028 | Trial primary completion date: Jan 2025 ➔ Dec 2028

Head-to-Head • Trial completion date • Trial primary completion date • Age-related Macular Degeneration • Hematological Disorders • Macular Degeneration • Ophthalmology • Retinal Disorders • Wet Age-related Macular Degeneration

Intra-arterial Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP) (clinicaltrials.gov) - P=N/A | N=247 | Completed | Sponsor: Xuanwu Hospital, Beijing | Recruiting ➔ Completed | N=376 ➔ 247 | Trial completion date: Sep 2025 ➔ Mar 2025

Enrollment change • Trial completion • Trial completion date • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombosis

Intra-coronary alteplase for extensive coronary artery thrombus. (PubMed, BMJ Case Rep) - No abstract available

Journal • Cardiovascular • Hematological Disorders • Thrombosis

Analysis of hemorrhagic transformation and intracerebral hemorrhage under combination therapy with alteplase and antiplatelets or anticoagulants, using the Japanese Adverse Drug Event Report database. (PubMed, PLoS One) - "HT and/or ICH signals were detected in patients receiving alteplase in combination with aspirin, P2Y12 inhibitors, cilostazol, ozagrel sodium, direct oral anticoagulants, warfarin potassium, heparin group, or argatroban. The findings from this study may help in understanding the risk of HT and ICH induced by rtPA in patients taking antiplatelet or anticoagulant medications, as well as in promoting the appropriate use of rtPA. Further prospective observational studies and randomized controlled trials are needed to assess these finding."

Adverse events • Journal • Cardiovascular • Cerebral Hemorrhage • Diabetes • Hematological Disorders • Hypertension • Ischemic stroke • Metabolic Disorders • Thrombosis

N-acetylcysteine (NAC) as an adjunct to intravenous fibrinolysis in patients with acute ischemic stroke: a single group study (NAC-Safety). (PubMed, Neuroscience) - "Recombinant tissue plasminogen activator (alteplase) and its derivative tenecteplase are approved for acute ischemic stroke (AIS), but their low recanalization rates remain a limitation. NAC administration resulted in a significant reduction in circulating large VWF multimers within hours of administration (-82 % for ULMWM-VWF, p < 0.001), aligning with preclinical findings. While NAC effectively cleaved circulating large VWF multimers in AIS patients, its combination with alteplase raises safety concerns, particularly in patients with a history of antiplatelet therapy."

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