TNKASE (tenecteplase) / Roche, Boehringer Ingelheim - LARVOL DELTA

ALLY II TNK: Adjunctive Intra-arterial Tenecteplase Following Mechanical Thrombectomy (ALLY) II Trial (clinicaltrials.gov) - P2/3 | N=132 | Not yet recruiting | Sponsor: ProMedica Health System

New P2/3 trial • Cardiovascular • Ischemic stroke

Early diagnosis and rapid thrombectomy with stent placement in distal vertebral artery stenosis (Mori Type C) with mild symptoms. (PubMed, Neuroradiol J) - "The patient received intravenous thrombolysis (IVT) with tenecteplase, followed by mechanical thrombectomy (MT), partial recanalization was achieved...Following intravenous administration of 500 mg acetylsalicylic acid, a Biotronik Orsiro 2.25 × 9 mm drug-eluting stent was placed, achieving complete recanalization (eTICI 3). Neurologic symptoms resolved completely post-intervention, and the patient received 300 mg clopidogrel...Follow-up ultrasound at 4 months confirmed good bilateral vertebral artery perfusion without restenosis, supporting the potential long-term benefits of this multimodal treatment approach. This case underscores the importance of advanced imaging for early detection and the role of thrombectomy and stenting in optimizing patient outcomes."

Journal • Atherosclerosis • Cardiovascular • Dyslipidemia • Hypertension • Metabolic Disorders • Otorhinolaryngology • Vertigo

Retrospective review of thrombolytic use for cardiac arrest due to suspected pulmonary embolism. (PubMed, Am J Emerg Med) - "This study provides new data regarding the outcomes of thrombolytic therapy in patients experiencing cardiac arrest due to suspected massive PE. Despite administration of thrombolytics, survival to hospital admission and subsequent survival to hospital discharge were seen in only a very small proportion of patients. Further research is necessary to optimize the management of this life-threatening condition."

Journal • Retrospective data • Cardiovascular • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Efficacy and safety of intra-arterial thrombolysis after endovascular reperfusion for acute ischemic stroke: a systematic review and meta-analysis of randomized trials. (PubMed, Int J Surg) - "IAT as an adjunct to successful EVT appears to enhance excellent functional outcome in patients with AIS-LVO without a significant increase in sICH and mortality."

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

Head-to-Head: Recombinant Human Prourokinase Versus Intravenous Thrombolytics in Acute Ischemic Stroke Within 4.5 Hours - A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. (PubMed, Clin Appl Thromb Hemost) - "Emerging alternatives like recombinant human prourokinase (rhPro-UK), reteplase, and tenecteplase offer potential improvements in efficacy, safety, and convenience, necessitating a comparative analysis.MethodsElectronic databases, including PubMed, ScienceDirect, and Cochrane Central, were comprehensively searched from inception till December 2024 for relevant studies. Safety outcomes, symptomatic intracranial hemorrhage (sICH), and mortality were not significantly different between alteplase and other thrombolytics. According to P-scores, Reteplase 18 + 18 mg ranked the best for excellent functional outcome (P-score = 0.89) and TNK 0.32 mg for good functional outcome (P-score = 0.99), while rhPro-UK 35 mg ranked the best for sICH (P-score = 0.89).ConclusionReteplase 18 + 18 mg and TNK 0.32 mg demonstrated superior functional outcomes compared to alteplase, while rhPro-UK 35 mg showed the best safety profile with the lowest sICH risk."

Clinical • Head-to-Head • Journal • Retrospective data • Review • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Endovascular thrombectomy with versus without intravenous thrombolysis for acute ischaemic stroke. (PubMed, Cochrane Database Syst Rev) - "The evidence does not currently support a clear benefit or harm for routine intravenous thrombolysis amongst people receiving endovascular thrombectomy. Amongst participants receiving endovascular thrombectomy, IVT did not demonstrate evidence of a difference in functional independence, excellent functional outcome, mortality, and asymptomatic intracranial haemorrhage, or symptomatic intracranial haemorrhage, when compared with no IVT. However, IVT did result in a higher rate of successful and complete revascularisation when compared with no IVT. Future research should include more high-quality trials to further evaluate the role of intravenous thrombolysis in people receiving endovascular thrombectomy to provide more robust data and further narrow the confidence intervals. Future research should also identify whether time- and person-specific factors influence the effect of IVT amongst those receiving endovascular thrombectomy."

Clinical • Journal • Review • Allergy • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Ischemic stroke

In brief: A new indication for tenecteplase (TNKase). (PubMed, Med Lett Drugs Ther) - No abstract available

Journal

Tenecteplase (TNK) in the Treatment of Intracerebral Hemorrhage (ICH) (clinicaltrials.gov) - P1 | N=5 | Not yet recruiting | Sponsor: Gaurav Gupta, MD | Initiation date: Jan 2025 ➔ Sep 2025

Trial initiation date • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

NAS-TNK: Neuronavigation-assisted Stereotactic Puncture With Tenecteplase for Acute Intracerebral Hemorrhage (clinicaltrials.gov) - P3 | N=732 | Recruiting | Sponsor: Beijing Tiantan Hospital | Not yet recruiting ➔ Recruiting

Enrollment open • Cerebral Hemorrhage • Hematological Disorders

Adjunctive intra-arterial thrombolysis following successful endovascular reperfusion in acute ischemic stroke: a systematic review and meta-analysis of seven randomized controlled trials. (PubMed, J Neurol) - "Adjunctive IAT following successful EVT in AIS-LVO patients led to improved 90-day excellent functional outcomes and reduced disability without increasing sICH or mortality risks."

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

Tenecteplase is here: navigating the shift of a stroke thrombolytic in the United States prior to FDA approval: a mini-review on rationale, barriers, and pathways. (PubMed, Front Neurol) - "The transition from alteplase (TPA) to tenecteplase (TNK) in acute ischemic stroke (AIS) management is gaining traction due to TNK's advantages in ease of administration and lower costs. The experience at Geisinger showcases a deliberate execution of a comprehensive change management strategy that resulted in successful and lasting outcomes. It may further serve as a blueprint for implementation of next generation thrombolytics yet to come."

FDA event • Journal • Review • Cardiovascular • Ischemic stroke

Tenecteplase for Minor Stroke: Does Sex Matter? (PubMed, J Am Heart Assoc) - No abstract available

Journal • Cardiovascular

Sex Differences in Outcomes After Tenecteplase for Minor Stroke: A Subanalysis of the TEMPO-2 Trial. (PubMed, J Am Heart Assoc) - "Tenecteplase was not associated with better clinical outcomes over nonthrombolytic control in female or male patients with minor ischemic stroke, despite more frequent recanalization. Fewer women treated with tenecteplase returned to baseline function compared with men."

Clinical • Journal • Cardiovascular • Ischemic stroke

Sex differences in outcomes and time to treatment in stroke patients treated with tenecteplase. (PubMed, Eur Stroke J) - "In our study, we did not find a significant difference between women and men in terms of 3-month good outcome. However, our study size may hinder its detection. Interestingly, we observed that women had a lower rate of sICH after tenecteplase. Women's workflow metrics were similar to men's, except for a higher rate of stroke with an unknown onset."

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

CuratED: The emergency medicine pharmacotherapy literature of 2024. (PubMed, Am J Emerg Med) - "Covered topics include guideline updates on seizure prophylaxis in traumatic brain injury, corticosteroid use in sepsis and acute respiratory distress and antibiotic prophylaxis in trauma. Additional topics include updates on thrombolytic therapy for acute ischemic stroke, including tenecteplase versus alteplase, anticoagulation reversal strategies with andexanet alpha and prothrombin complex concentrate, and the use of tranexamic acid in traumatic brain injury, ketamine versus etomidate for intubation in critically ill adults, expert consensus on heart failure hospitalization management, geriatric emergency medication safety recommendations, and emerging data on dual antiplatelet therapy for stroke management."

Journal • Review • Acute Respiratory Distress Syndrome • Cardiovascular • CNS Disorders • Congestive Heart Failure • Epilepsy • Heart Failure • Infectious Disease • Ischemic stroke • Septic Shock • Vascular Neurology

BRIDGE-TNK: Endovascular Treatment With Versus Without Intravenous rhTNK-tPA in Stroke (clinicaltrials.gov) - P2/3 | N=550 | Completed | Sponsor: Xinqiao Hospital of Chongqing | Recruiting ➔ Completed | Trial completion date: Mar 2026 ➔ Feb 2025 | Trial primary completion date: Dec 2025 ➔ Dec 2024

Trial completion • Trial completion date • Trial primary completion date • Cardiovascular • Ischemic stroke

Risk of intracerebral haemorrhage with tenecteplase versus alteplase in acute ischaemic stroke: a meta-analysis. (PubMed, J Neurol) - "Our study provides the best evidence to date that TNK has a similar risk of ICH to ALT in AIS, with a very low incidence of symptomatic ICH, supporting that TNK has a good safety profile in terms of ICH."

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

Tenecteplase-assisted transapical drainage of tuberculous pyopericardium. (PubMed, J Invasive Cardiol) - No abstract available

Journal • Cardiovascular

Tenecteplase compared to alteplase before mechanical thrombectomy enhances 1-h recanalization and reduces disability in large-vessel occlusion. (PubMed, J Neurol) - "Real-world observations reveal tenecteplase has increased ER rates compared to alteplase within 1 h of IVT and reduced disability in LVO patients. Further randomized trials are warranted to evaluate the effect of tenecteplase rapid bridging mechanical thrombectomy."

Journal • Cardiovascular • Thrombosis • ER

Hemifacial Spasms or Focal Aware Seizures: The Role of Video-EEG. (PubMed, Cureus) - "Although his motor symptoms improved after receiving tenecteplase (TNK), the HFS persisted, prompting the use of continuous video-EEG to differentiate between cortical myoclonus and HFS. Video-EEG is essential for distinguishing HFS from focal aware seizures, identifying high-frequency ipsilateral muscle artifacts in HFS versus interictal or ictal EEG patterns contralateral to facial contractions in seizures. This case highlights key features to aid neurologists in differentiating these conditions."

Journal • Video • Cardiovascular • CNS Disorders • Congestive Heart Failure • Epilepsy • Heart Failure • Movement Disorders

Retrobulbar Ocular Hematoma After Tenecteplase Administration for Acute Right Thalamocapsular Stroke After Bilateral Blepharoplasties (P3-14.016). (PubMed, Neurology) - "Dr. Zhang has nothing to disclose."

Journal • Aesthetic Medicine • Cardiovascular • Chronic Kidney Disease • Critical care • Hypertension • Nephrology • Nicotine Addiction • Optic Neuritis • Renal Disease

Comparison of Hemorrhagic and Non-Hemorrhagic Access-Site Complications with Tenecteplase vs Alteplase Bridging Thrombolysis Prior to Stroke Thrombectomy (P5-13.009). (PubMed, Neurology) - "Dr. Hendrix has nothing to disclose."

Clinical • Journal • Retrospective data • Atrial Fibrillation • Cardiovascular • Coronary Artery Disease • Hematological Disorders

Intracranial and Extracranial Systemic Complications with Alteplase vs Tenecteplase among Large Vessel Occlusion Stroke Patients Undergoing Thrombectomy (P7-13.013). (PubMed, Neurology) - "Dr. Hendrix has nothing to disclose."

Clinical • Journal • Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Ischemic stroke • Subarachnoid Hemorrhage

Experience in Treating Acute Ischemic Stroke with Tenecteplase at a Single Center in Bogotá, Colombia (P10-14.016). (PubMed, Neurology) - "Mr. Monsalve has nothing to disclose."

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

Synchronous Acute Ischemic Stroke and Acute Myocardial Infarction: A Case Report. (PubMed, Cureus) - "Tenecteplase 0.25mg/kg was administered, and the patient subsequently underwent thrombectomy...The patient received 300mg rectal aspirin and IV cangrelor. He was continued on aspirin/clopidogrel dual therapy, and the patient was subsequently discharged and instructed to follow up with a cardiologist. This case report underscores the necessity of a holistic approach to management guidelines for patients presenting with synchronous AIS and AMI due to the potential complications associated with the treatment of either AIS or AMI."

Journal • Cardiovascular • CNS Disorders • Ischemic stroke • Myocardial Infarction