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

Heed The Warning: A Case Report on Capsular Warning Syndrome. (PubMed, Clin Pract Cases Emerg Med) - "Capsular warning syndrome is a rare clinical entity with an incidence ranging from 1.5-5% in stroke patients. Its recognition is crucial when making decisions concerning management, as resolution of symptoms should still garner a high level of attention given that the the increased risk of stroke with permanent neurological disability is highest within the first 48 hours. The role of thrombolysis continues to be an area of focus as its benefit has not yet been determined but continues to be the mainstay therapy in the correct clinical setting. This is especially true in the cases of recurrent episodes post thrombolysis, which does not preclude the diagnosis of capsular warning syndrome but should heighten the need for acute management of these patients and close monitoring. This case illustrates its unique presentation and the need for increased recognition and understanding within the field of emergency medicine."

Journal • Cardiovascular • CNS Disorders • Coronary Artery Disease • Hematological Disorders • Human Immunodeficiency Virus • Infectious Disease • Ischemic stroke • Mood Disorders

Response to the letter to the editor regarding "safety of tenecteplase versus alteplase for intravenous thrombolysis in acute ischemic stroke patients with direct oral anticoagulation". (PubMed, Neurol Res Pract) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Letter to the editor regarding "Safety of tenecteplase versus alteplase for intravenous thrombolysis in acute ischemic stroke patients with direct oral anticoagulation: experience from a German stroke center" by Mers et al. (PubMed, Neurol Res Pract) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Effect of Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage on Aphasia and Dysarthria Outcomes: Post-hoc Analysis of MISTIE III (ISC 2026) - "This study investigated the trajectory and predictors of speech recovery in a phase 3 clinical trial of patients with severe ICH. We conducted a post-hoc analysis of all 499 participants from the Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE III) trial, of which 299 had complete NIHSS subscores for best language (Q9) and dysarthria (Q10) at days 30, 180, and 365... Aphasia and dysarthria are common yet potentially reversible sequelae of ICH. Laterality and residual hematoma volume are the strongest predictors of recovery. MIS may facilitate earlier resolution but was not independently associated with one-year language recovery."

Retrospective data • Surgery • Cerebral Hemorrhage • Hematological Disorders

Cost Burden and Characterization of Tenecteplase Waste in Acute Ischemic Stroke: A Risk-Based Analysis Across Four Certified Stroke Centers (ISC 2026) - "Increased preference of tenecteplase (TNK) over alteplase has resulted in concerns over excess medication waste costs, as prior to FDA approval of TNK for AIS in March 2025, no reimbursement program was available for this medication.Objectives: This study aimed to characterize rates of TNK waste across four urban hospitals including a Comprehensive Stroke Center (CSC), Thrombectomy Certified Center (TSC), and two Primary Certified Centers (PSCs) when utilized for AIS in the emergency department (ED). Pharmacist bedside mixing of TNK may lead to lower rates of TNK waste, reducing overall cost burden to the healthcare system."

Cardiovascular • Ischemic stroke

Tenecteplase versus Alteplase for Acute Ischemic Stroke Beyond 4.5-Hour Window: A Bayesian Network Meta-Analysis of Randomized Controlled Trials (ISC 2026) - "Both tenecteplase and alteplase improve excellent functional outcomes compared with BMT in patients with AIS beyond 4.5 hours. Functional outcomes did not differ significantly between tenecteplase and alteplase. However, alteplase was associated with a higher risk of sICH, whereas tenecteplase appeared safer and ranked as the most effective option for functional recovery."

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

LYS241: A Novel Humanized Antibody Counteracting tPA-Mediated Neurotoxicity and BBB Disruption in Stroke (ISC 2026) - "LYS241 was administered both as a monotherapy and in combination with alteplase (rtPA) or tenecteplase (TNK), within either an acute or extended therapeutic window following stroke. These findings highlight its potential as a standalone therapy or in combination with thrombolysis and/or thrombectomy . LYS241 is currently progressing through IND/CTA-enabling studies in preparation for a first-in-human clinical trial."

First-in-human • Cardiovascular • CNS Disorders • Ischemic stroke • Vascular Neurology

Effect of IAT plus MT versus MT alone on excellent functional outcome (mRS 0-1) at 90 days (ISC 2026) - "IAT + MT significantly increased the likelihood of achieving the excellent functional outcome (RR = 1.23, 95% CI 1.11 – 1.36), with consistent benefit for tenecteplase and alteplase, and among the individuals with varying stroke severity. Outcomes suggest that adjunctive IAT after MT improves the likelihood of complete functional recovery without increasing mortality or symptomatic hemorrhage, although there is a slight increase in total ICH risk that might be noted. Additional risk-benefit analysis is necessary for the refinement of candidate, agent, and dose selection."

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

Comparison of Tenecteplase Versus Alteplase Treatment for Intravenous Thrombolysis Using Regression Discontinuity Analysis (ISC 2026) - "Baseline presentation characteristics, including age, NIHSS, ASPECTS, and last know well to thrombolysis time, were not significantly different between groups at the switch cutoff date, supporting the RD assumption (Figure 1A-1D). In RD analysis, we observed no discontinuity in ICH at the TNK cutoff, indicating no statistically significant difference between tPA and TNK among patients near the cutoff (risk difference:-0.03; 95%[-0.14,0.09]) (Figure 1.E), nor in the secondary outcomes of sICH (risk difference:-0.10; 95%[-0.21,0.0008]), functional independence at 90 days (risk difference:0.27; 95%[-0.19,0.73]), or mortality (risk difference:-0.06; 95%[-0.16,0.03]).Conclusion Our pseudo-randomized study design corroborated findings from RCT conducted outside the US, demonstrating equivalent safety and efficacy measures in tenecteplase and alteplase for treatment of acute ischemic stroke."

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

Alteplase vs. Tenecteplase: Comparison of Treatment Times and Hemorrhagic Complications in a large US health care system (ISC 2026) - "IV TNK is $1715.53 cheaper on average in our large multi-state system compared to alteplase. Therefore, the IV TNK cohort studied here (n=781) represents 1.34 million dollars in savings"

Cardiovascular • Hematological Disorders • Ischemic stroke

Thrombolysis for Pediatric Stroke: Alteplase (ISC 2026) - No abstract available

Clinical • Cardiovascular • Pediatrics

Strategy for Improving Stroke Treatment Response (SISTER): A Phase-2 Clinical Trial of TS23, a novel mechanism for improving outcomes in acute ischemic stroke (ISC 2026) - P2 | "Introduction: Plasminogen activators (Alteplase and Tenecteplase) for acute ischemic stroke (AIS), while effective, suffer from limitations and untoward effects. SISTER will rigorously test the safety and preliminary efficacy of TS23 among patients with AIS within 4.5-24 hours of last known well. If the trial is successful, pivotal testing of TS23 for AIS will be planned."

Clinical • P2 data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke • Thrombosis

Tenecteplase-Associated Complications: A Retrospective Analysis Across a Regional Stroke System (ISC 2026) - "TNK has favorable attributes including single-dose administration and lower complication and mortality rates compared to alteplase. Post-TNK complication rates were similar (not statistically significant) across stroke center levels, suggesting comparable safety profiles regardless of facility resources. Additionally, rates of complications were similar to published data by larger academic settings. These findings support TNK use in diverse settings, but vigilance for complications remains crucial."

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

Tenecteplase versus Alteplase for Delayed-Window Thrombolysis: Indirect Comparison of Randomized Controlled Trials using the Bucher Method (ISC 2026) - "In this first indirect comparison of Tenecteplase and Alteplase for delayed-window thrombolysis, efficacy and safety profiles appeared comparable. While these findings support the potential interchangeability of agents in this setting, they are limited by the absence of direct head-to-head trials. Large, randomized comparative studies are needed to guide optimal thrombolysis selection in the delayed window."

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

Leech and Earthworm Extract Injection Improves Functional Outcomes in Diabetic Stroke Patients Post-thrombolysis: A Multicenter Registry Study (ISC 2026) - P | "Consecutive patients treated with alteplase or tenecteplase within 4.5 hours of symptom onset and with diabetes mellitus (DM) or hypoglycemic agent use were included, while those treated with endovascular therapy were excluded. sICH was observed in 1 vs 3, and death in 2 vs 9 for the SXT and non-SXT group respectively.CONCLUSIONSSXT significantly improved functional outcomes in diabetic AIS patients following thrombolysis. The effects of SXT in diabetic AIS patients undergoing IVT warrant further investigation."

Clinical • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Diabetes • Hematological Disorders • Ischemic stroke • Metabolic Disorders • Reperfusion Injury

Early Intravenous Antiplatelet Therapy Combined with Intravenous Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Trials (ISC 2026) - "Background: Intravenous thrombolysis (IVT) with alteplase is the standard approved pharmacologic reperfusion therapy for acute ischemic stroke (AIS)... Our findings suggest that early antiplatelet therapy after intravenous thrombolysis in AIS does not improve functional independence or survival and may increase the risk of sICH. Further large-scale RCTs are required to better define its role in clinical practice."

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

Comparative Efficacy and Safety of Tenecteplase vs. Alteplase in the Management of Acute Ischemic Stroke: Systemic Review and Meta-Analysis (ISC 2026) - "For adverse events overall, Tenecteplase had a higher RR of 0.24 (95% CI: 0.14, 0.31), indicating more frequent adverse events than Alteplase (RR 0.17, 95% CI: 0.08, 2.1).ConclusionTenecteplase offers better survival outcomes in acute ischemic stroke, while Alteplase provides greater functional recovery. These findings aid clinical decision-making with low risk of bias"

Retrospective data • Review • Cardiovascular • Hematological Disorders • Infectious Disease • Ischemic stroke

Comparative Efficacy and Safety of Tenecteplase versus Reteplase in Acute Ischemic Stroke: An Indirect Meta-Analysis (ISC 2026) - "Introduction: Intravenous thrombolysis with alteplase (tPA) has long been the standard for acute ischemic stroke (AIS), but its narrow therapeutic window, complex administration, and risk of symptomatic intracerebral hemorrhage have prompted exploration of alternative fibrinolytics. This indirect comparison indicates that TNK is associated with lower odds of achieving an excellent functional outcome at 90 days compared to reteplase. Since there are no direct head-to-head trials, these findings highlight a critical gap in evidence and emphasize the need for well-designed, sufficiently powered RCTs directly comparing TNK and reteplase in AIS. Such studies are vital to guide optimal thrombolytic choice, considering stroke severity and personalized treatment approaches."

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

Body Weight-Adapted Fibrinolysis Dosing Schemes in Acute Ischemic Stroke and ST-Elevation Myocardial Infarction: A Risk–Benefit Analysis (ISC 2026) - "Introduction: Body weight (BW)-adapted dosing schemes for tenecteplase (TNK) and alteplase (ALT) vary. Outcomes were comparable between the two BW dosing schemes for TNK and ALT across BW categories and were supported by other trials in AIS and STEMI. Limitations include the uncertain accuracy of BW measurements, low proportion of sICH across trials, lack of adjustment for baseline variables across trial datasets, and exploratory nature of the analysis. The safety of each dosing scheme was similar in patients with low BW."

Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke • Myocardial Infarction

Outcomes of acute ischemic stroke patients receiving IV tenecteplase versus IV alteplase with and without thrombectomy in real world setting (ISC 2026) - "The likelihood of major neurological improvement at 24 hours showed a marginal association with TNK and thrombectomy treatment (aOR 1.96, CI 0.615-6.245, p=0.255). In conclusion, this single center, real-world study, provides compelling evidence that IV TNK is associated with a higher incidence of intracranial hemorrhage when compared to IV tPA in AIS patients who underwent MT."

Clinical • Real-world • Real-world evidence • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke • Subarachnoid Hemorrhage

Cocaine Use Does Not Impact Outcomes in Intracerebral Hemorrhage (ISC 2026) - "We assessed long-term outcomes of cocaine-associated ICH in a large, pooled analysis of multiple ICH studies that included active cocaine users. We harmonized individual and patient-level data from two randomized clinical trials (Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 [ATACH 2] and Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III [MISTIE III]) and one prospective observational study (Ethical/Racial Variations of Intracerebral Hemorrhage [ERICH]) with available modified Rankin scale (mRS) between 90-180 days... From a pooled cohort of 4,702 ICH patients, 128 patients had cocaine-associated ICH. Cocaine users were younger (53.7 vs 62.1 years), more frequently Black (60.2% vs 25%), smokers (37.3% vs 12.8%), and less likely to have comorbidities or use anticoagulants. Cocaine use was associated with non-lobar hematoma (83.6% vs 71.1%) and more frequently received ventricular drainage or ICP monitoring (26.6% vs 17.1%)."

Cerebral Hemorrhage • Hematological Disorders

Desirability of Outcomes Ranking of Unknown Onset Stroke Thrombolysis Guided by Advanced Imaging: An Individual Patient Data Meta-Analysis (ISC 2026) - "Introduction : Meta-analyses of RCTs of intravenous alteplase (IVT) for stroke with unknown time of onset (SUTO), selected by advanced imaging have shown better functional outcomes than placebo or standard care, but with higher mortality and symptomatic intracerebral hemorrhage (SICH)...The greatest separation was observed at DOOR > 4 vs. ≤4, with a probability of 54.8% (95% CI, 51.4–58.1) (Fig 3).Conclusions : DOOR analysis demonstrated a more desirable overall outcome with IVT for SUTO. The results suggest that IVT was associated with more favorable DOOR ranking, particularly within the better DOOR ranking strata that reflect a favorable balance between clinical efficacy and safety."

Metastases • Retrospective data • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders

Analysis of Stroke Clots Retrieved Via Mechanical Thrombectomy in Patients with Thromboinflammation (ISC 2026) - "Acute treatments are limited to thrombolysis (alteplase or tenecteplase) and/or mechanical thrombectomy (MT), yet resistance to fibrinolysis is common in the setting of thromboinflammation. Thrombi from patients with acute thromboinflammation demonstrate distinct architecture that may contribute to fibrinolysis resistance. COVID-associated clots serve as a model to uncover features relevant across other thromboinflammatory states. These findings highlight potential targets for improved thrombolysis and underscore the need for studies testing alternative agents in this high-risk population."

Clinical • Cardiovascular • Infectious Disease • Inflammation • Novel Coronavirus Disease • Respiratory Diseases

Adjunctive Intra-arterial Thrombolysis after Thrombectomy in Large Vessel Occlusion – A Network Meta-Analysis of Randomized Controlled Trials Evaluating Agents and Dosages (ISC 2026) - "For safety, no IAT agent significantly reduced or increased the risk of sICH.Conclusion Intra-arterial alteplase 0.225mg/kg and tenecteplase 0.125 mg/kg appear most likely to improve functional recovery following successful EVT compared to controls, though our results are limited by small sample sizes in certain treatment nodes, and dichotomization of outcomes which lack granularity. Further head-to-head trials are needed."

Retrospective data • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

Intravenous thrombolysis and antiplatelet therapy of acute minor stroke: a systematic review and pairwise and bayesian network meta-analysis of randomized controlled trials (ISC 2026) - "Subgroup analyses ranked the effects of different antiplatelet regimens (e.g., dual antiplatelet therapy [DAPT], aspirin monotherapy) and thrombolytic agents (e.g., alteplase, tenecteplase) on 90-day functional outcomes, symptomatic intracranial hemorrhage (sICH), and all-cause mortality. Pairwise meta-analysis revealed no significant difference between the IVT and SMT groups in achieving excellent functional outcomes at 90 days (modified Rankin Scale [mRS] 0–1: odds ratio [OR] 0.85, 95% confidence interval [CI] 0.72–1.00) or good functional outcomes (mRS 0–2: OR 0.81, 95% CI 0.65–1.01), whereas IVT was associated with a markedly increased risk of sICH (OR 5.17, 95% CI 1.97–13.55). In patients with mild ischemic stroke within 12 hours of onset, SMT is noninferior to IVT and significantly reduces the risk of sICH. Among SMT regimens, dual antiplatelet therapy (DAPT) based on aspirin and clopidogrel may represent the optimal treatment option that balances both efficacy..."

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