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

Bridging thrombolysis versus direct thrombectomy in acute ischemic stroke with large vessel occlusion: a network meta-analysis. (PubMed, J Neurol) - "In comprehensive consideration of efficacy and safety, 0.25 mg/kg tenecteplase + EVT may represent a preferable treatment option for AIS-LVO patients compared to other reperfusion strategies."

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

Use of and outcomes related to intrapleural enzyme therapy for complicated parapneumonic effusion and empyema in an integrated health system. (PubMed, Chest) - "Full MIST2 dosing was infrequent with a high degree of facility-level variation. Given the protective association, hospitals should consider delivering full MIST2 dosing."

Journal • Infectious Disease

Efficacy and safety of adjunctive eptifibatide or argatroban versus control for acute ischemic stroke: A systematic review and network meta-analysis of randomized control trials (ASH 2025) - "Introduction: Acute ischemic stroke is a major cause of disability and mortality, with treatment mainlylimited to intravenous alteplase thrombolysis. Functional Independence (mRS 0-1): Eptifibatide showed superior odds versus control (OR 1.12 [0.65-1.95]) and Argatroban (OR 1.82 [0.61-5.45]), with wide confidence intervals. Argatroban versus controlyielded OR 1.05 [0.59-1.86], indicating uncertainty. Bayesian analysis showed minimal effect for Controlversus Argatroban = -0.046 [-0.65, 0.59], and slight advantage for Control versus Eptifibatide = 0.205 [-0.37, 0.78], with uncertainty."

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

Subacute edema progression after acute ischemic stroke: impact of intravenous alteplase administration and reperfusion degree. (PubMed, Front Neurol) - "Alteplase administration prior to EVT did not impact the subacute edema progression in our cohort, whereas successful reperfusion was strongly associated with reduced edema progression, particularly at later timepoints. These results suggest that alteplase administration according to current guidelines is unlikely to contribute to accelerated edema progression and emphasize that achieving high-grade reperfusion is crucial for reducing secondary injury."

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

Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase. (PubMed, J Stroke Cerebrovasc Dis) - "An increase in sBP within the first 24h was associated with worse neurological and functional outcomes at 3 months, while higher baseline sBP was linked to worse neurological outcomes and sICH in acute ischemic stroke patients treated with alteplase."

Journal • Cardiovascular • Ischemic stroke

Low-Dose Catheter-Directed Thrombolysis for Massive Pulmonary Embolism: A Case Report Highlighting Dosing Considerations in Asian Patients. (PubMed, Case Rep Cardiol) - "Low-dose CDT in massive PE could be lifesaving despite the presence of absolute alteplase contraindications. Patients with contraindications, a high risk of bleeding, or of Asian race may benefit more from the low-dose alteplase regimen."

Journal • Cardiovascular • Hematological Disorders • Musculoskeletal Diseases • Orthopedics • Pulmonary Embolism • Respiratory Diseases • Subarachnoid Hemorrhage • Thrombosis

Direct thrombectomy versus bridging alteplase medicine in anterior circulation stroke following endovascular therapy: a multi-center cohort study. (PubMed, Eur J Med Res) - "Pre-EVT rt-PA did not improve functional outcomes or reduce mortality in AIS patients. While rt-PA showed a trend toward higher reperfusion rates, this did not translate to clinical benefit. Hemorrhage risks were similar between groups."

Journal • Cardiovascular • Hematological Disorders • Ischemic stroke

Chemical Optimization of Cerebral Embolectomy 2 (CHOICE 2) trial: study protocol. (PubMed, Stroke Vasc Neurol) - "This trial will provide evidence whether rescue intra-arterial thrombolysis improves clinical outcome in patients with LVO stroke who achieve successful or complete angiographic reperfusion following MT."

Journal • Cardiovascular • Ischemic stroke

Tenecteplase vs Alteplase in Mechanical Prosthetic Heart Valve Thrombosis: The TENET Randomized Clinical Trial. (PubMed, JAMA Cardiol) - "Furthermore, the relative ease of drug administration with tenecteplase may translate to greater clinical benefit in a real-world setting. Clinical Trials Registry of India: CTRI/2022/10/046127."

Clinical • Journal • Cardiovascular • Hematological Disorders • Thrombosis

Alteplase 4.5 to 24 Hours After Acute Ischemic Stroke. (PubMed, JAMA) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Alteplase 4.5 to 24 Hours After Acute Ischemic Stroke-Reply. (PubMed, JAMA) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Alteplase 4.5 to 24 Hours After Acute Ischemic Stroke. (PubMed, JAMA) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Switching from alteplase to tenecteplase for stroke thrombolysis: short-term effects on treatment metrics and early functional outcomes. (PubMed, BMC Neurol) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Acute Supraventricular Tachycardia Revealing a Massive Saddle Pulmonary Embolism in a Young Male With Rhinovirus Infection: A Case Report. (PubMed, Cureus) - "During admission, he developed recurrent and refractory episodes of SVT, ultimately necessitating systemic thrombolysis with intravenous alteplase. Arrhythmia control was achieved with digoxin and bisoprolol, and follow-up echocardiography showed normalization of right ventricular function...This case highlights SVT as a rare but clinically significant presentation of acute PE, underscoring the importance of considering PE in patients with new-onset tachyarrhythmias and hemodynamic compromise. Early recognition and timely management are critical to preventing morbidity and mortality in such presentations."

Journal • Cardiovascular • Infectious Disease • Pulmonary Embolism • Respiratory Diseases • Venous Thromboembolism • Ventricular Tachycardia

Thrombolysis With the Nonimmunogenic Staphylokinase for Acute Ischemic Stroke in FORPI Registry: An Observational Study. (PubMed, Stroke) - "These safety and efficacy outcomes were comparable with FRIDA (Fortelyzin Randomized Investigation Compared With Alteplase) randomized clinical trial results. The presented data suggest that intravenous thrombolysis with the nonimmunogenic staphylokinase is safe and effective in routine clinical practice when used within 4.5 hours of AIS symptoms onset. These findings should encourage the wider usage of thrombolytic therapy with the nonimmunogenic staphylokinase for suitable patients."

Clinical • Journal • Observational data • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

Outcomes After Intravenous Alteplase / Tenecteplase With or Without Shuxuetong Injection in Routine Clinical Practice (clinicaltrials.gov) - P=N/A | N=2008 | Recruiting | Sponsor: Dongzhimen Hospital, Beijing | Not yet recruiting ➔ Recruiting | Trial primary completion date: Apr 2025 ➔ Dec 2025

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

Alteplase 4.5 to 24 h after stroke with potentially salvageable brain tissue increased independence at 90 d. (PubMed, Ann Intern Med) - "Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text]."

Journal • Cardiovascular

Tenecteplase Versus Alteplase for First-Pass Reperfusion in Basilar Artery Occlusion Stroke Thrombectomy. (PubMed, Ann Neurol) - "In this multicenter BAO cohort, TNK increased the odds of achieving FPE compared with TPA. As FPE strongly predicted functional recovery, these findings suggest TNK may confer a reperfusion advantage with potential clinical benefit, although a direct outcome effect was not demonstrated. ANN NEUROL 2025."

Journal • Cardiovascular • CNS Disorders

Impact of early versus delayed intrapleural fibrinolytics on pleural infection outcomes: an observational study (BTS WM 2025) - "All received drainage ± fibrinolytics (Alteplase 10 mg + DNase 5 mg daily for up to 3 days). View this table: View inline View popup Download powerpoint Abstract P271 Table 1 Conclusions Early fibrinolytic therapy appears to reduce hospital stay and chest tube duration without increasing mortality or requirement for surgery. Further research is needed."

Clinical • Observational data • Infectious Disease

Comparative Safety of Tenecteplase and Alteplase in Direct Oral Anticoagulant-Pretreated Patients With Acute Ischemic Stroke. (PubMed, Clin Pharmacol Ther) - "Time-split Cox analysis confirmed that excess risk was confined to the first 24 hours. Among patients pretreated with DOACs, tenecteplase was associated with higher early risk of hemorrhagic transformation and mortality than alteplase, underscoring the need for vigilance during the first 24 hours after treatment."

Journal • Cardiovascular • Cerebral Hemorrhage • Gastroenterology • Hematological Disorders • Ischemic stroke • Subarachnoid Hemorrhage

Low dose Intrapleural Fibrinolytic Reteplase as a Minimally Invasive Treatment in Complex Pleural Effusion in Filipino Patients: Case Series (APSR 2025) - "We are evaluating the use of Reteplase, as it is cheaper compared to Alteplase, as a single agent for IFT in the management of complicated pleural effusions...All of the patients had adequate radiographic resolution and eventually discharged and improved. Conclusion : Reteplase use for IFT has a potential of less invasiveness, less cost, and less morbidity compared to surgery in the management of complicated pleural effusions."

Clinical • Pleural effusion • Cardiovascular • Hypertension • Infectious Disease • Myocardial Infarction • Respiratory Diseases • Tuberculosis

Triumph Over Empyema: Post-Streptokinase Recovery (APSR 2025) - "Discussion : Streptokinase is a cost-effective fibrinolytic agent with proven efficacy and safety, making it the most widely used option globally. Although it has lower efficacy than alteplase, streptokinase can be effective in treating loculated empyema in resource-limited centre, with successful outcomes and no complications."

Cough • Infectious Disease • Pneumonia • Respiratory Diseases • Tuberculosis

Successful Drainage of Complex Effusion in Empyema Thoracis with Intrapleural Alteplase and DNase Therapy (APSR 2025) - "Alteplase and DNase therapy facilitates the breakdown of fibrinous septations, enhancing drainage and improving clinical outcomes. This approach may reduce morbidity and hospital stay while avoiding invasive procedures in select patients."

Cough • Infectious Disease • Pneumonia • Respiratory Diseases

Pharmaceutical Compatibility of Tissue Plasminogen Activator and DNase. (PubMed, Respiration) - "Methods We prepared the following combinations of tPA (Actilyse, Boehringer Ingelheim B.V.) and DNase (Pulmozyme, Roche Nederland B.V.): undiluted (10 mg tPA + 5 mg DNase), diluted in 50 mL saline, and diluted in 500 mL saline...Conclusion Our findings demonstrate that tPA and DNase are pharmaceutically compatible when mixed and diluted in normal saline. This supports the feasibility of concurrent intrapleural administration, which may reduce labor intensity, improve protocol adherence, and lower the risk of iatrogenic infections in patients with pleural infections."

Journal • Infectious Disease

A Risk Worth Taking: Fibrinolytics in Post-Splenectomy Thalassaemic with Empyema (APSR 2025) - "A chest drainage was inserted, and the pleural fluid analysis confirmed an exudative effusion, culture grew Enterobacter roggenkampii which sensitive to Cefepime and Ciprofloxacin...Intrapleural alteplase 5 mg and 5 mg dornase alfa were administered into both locules for 3 cycles over a 3-day period...Discussion : Fibrinolytic therapy in high-risk patients particularly those with a history of surgical intervention, thalassemia, low haemoglobin levels, and an elevated risk of bleeding—can be considered a safe and justifiable approach. It significantly reduces the likelihood of requiring surgical decortication and helps prevent the progression to severe sepsis."

Beta-Thalassemia • Cough • Genetic Disorders • Infectious Disease • Pulmonary Disease • Respiratory Diseases • Septic Shock • CRP