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

Optimal Duration of Ultrasound-Facilitated Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Retrospective Cohort Study. (PubMed, Biomedicines) - "Compared with the group with a USCDT ≥ 40 h, the group with a USCDT < 20 h had a lower odds ratio for 30-day all-cause mortality (OR: 0.36, 95% CI: 0.07-1.81). A similar benefit was observed for a USCDT 20-29 h. USCDT < 20 or 20-29 h (mean 15-20 mg alteplase) may provide an optimal balance between efficacy and safety by reducing 30-day all-cause mortality and major bleeding in patients with acute PE."

Journal • Retrospective data • Cardiovascular • Critical care • Pulmonary Embolism • Respiratory Diseases

Pre-Thrombolysis Biological Correlates of Admission Glasgow Coma Scale in Older Adults with Acute Ischemic Stroke: A Retrospective Single-Center Cohort Study. (PubMed, Medicina (Kaunas)) - "Materials and This retrospective single-center cohort included 95 unique patients aged ≥65 years, all treated with intravenous alteplase between 2020 and 2024...These associations do not establish causality, independence from unmeasured lesion location or infarct volume, predictive utility, or early neurological recovery. Prospective external validation is required."

Biomarker • Journal • Retrospective data • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Ischemic stroke • CRP

Early Outcomes of Bolus Thrombolysis Plus Manual Aspiration Thrombectomy Using Conventional Catheters for Intermediate-High- and High-Risk Acute Pulmonary Embolism. (PubMed, J Clin Med) - "BT-MAT comprised catheter-directed bolus alteplase injection followed by manual aspiration using conventional 7- to 8-Fr catheters or sheaths... BT-MAT was technically feasible and showed favorable early clinical outcomes in this small series. Further prospective studies are warranted to evaluate its efficacy and safety."

Journal • Cardiovascular • Heart Failure • Pulmonary Embolism • Respiratory Diseases

Cost-effectiveness of Tenecteplase Versus Alteplase for Acute Ischemic Stroke in Canada Based on the AcT Trial. (PubMed, Can J Neurol Sci) - "This analysis represents the first to assess the cost-effectiveness of tenecteplase as an alternative to alteplase in the treatment of AIS in the Canadian setting. Though all benefits related to its simplified bolus administration were not considered, results robustly demonstrate tenecteplase represents a high-value strategy. Together with the accumulating clinical evidence, this study may help support decisions to adopt tenecteplase on hospital formularies."

HEOR • Journal • Cardiovascular • Ischemic stroke

Acute Mechanical Mitral Valve Thrombosis Treated by Endovascular Recombinant Tissue Plasminogen Activator in a 2-Year-Old. (PubMed, JACC Case Rep) - "Catheter-directed, continuous low-dose alteplase can promptly restore prosthetic mitral valve function in stable pediatric patients, provided strict monitoring and anticoagulation stewardship."

Journal • Cardiovascular • Hematological Disorders • Pediatrics • Thrombosis

Case Report: Ischemic stroke revealing carotid fibromuscular dysplasia with multiple metabolic disturbances in a 42-year-old man. (PubMed, Front Cardiovasc Med) - "Intravenous thrombolysis with alteplase was administered within the therapeutic window...The coexistence of FMD with multiple metabolic disturbances in this case, while likely coincidental, underscores the complexity of stroke etiology and the importance of a comprehensive diagnostic approach that does not prematurely attribute stroke to common risk factors alone. Carotid FMD, though rare, is a treatable cause of stroke, and early diagnosis via DSA can guide appropriate management to prevent recurrence."

Journal • Atherosclerosis • Cardiovascular • Diabetes • Dyslipidemia • Fibrosis • Hematological Disorders • Hypertriglyceridemia • Immunology • Ischemic stroke • Metabolic Disorders • Severe Hypertriglyceridemia

FIB-TB: Efficacy and Safety of Intrapleural Fibrinolytic Therapy in Tuberculous Pleural Effusion Versus Non-Tuberculous Pleural Infection (clinicaltrials.gov) - P=N/A | N=160 | Not yet recruiting | Sponsor: National University of Malaysia

New trial • Infectious Disease • Respiratory Diseases

Low-Dose Slow-Infusion Alteplase for a Thrombus-Dominant ST-Segment Elevation Myocardial Infarction in a Young Adult: A Case Report and Narrative Review. (PubMed, Anatol J Cardiol) - No abstract available

Journal • Cardiovascular • Myocardial Infarction • Thrombosis

Treatment first, transport second: rethinking stroke management with mobile stroke units-A systematic review and meta-analysis of controlled trials. (PubMed, Front Neurol) - "We found no significant differences considering the impact of onboard and remote neurologist models in MSUs, highlighting that remote neurologists in MSUs could potentially be a more cost-effective model. PROSPERO; registration number: CRD420261297860."

Clinical • Journal • Retrospective data • Review • Cardiovascular

Role of Thrombectomy Technique in Alteplase Bridging Intravenous Thrombolysis for Basilar Artery Occlusion. (PubMed, J Am Heart Assoc) - "Bridging IVT was associated with differences in clinical and safety outcomes across EVT strategies. However, no statistically significant interaction was observed between treatment allocation and EVT technique. Therefore, these findings should be interpreted as descriptive and hypothesis-generating rather than evidence of true differences in treatment effect."

Journal • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders

CHOICE2: CHemical OptImization of Cerebral Embolectomy 2 (CHOICE 2). (clinicaltrials.gov) - P3 | N=440 | Completed | Sponsor: Hospital Clinic of Barcelona | Active, not recruiting ➔ Completed

Trial completion • Cardiovascular • Ischemic stroke

Less is More: Low-Dose Intrapleural Fibrinolysis for Complex Parapneumonic Pleural Effusions - Safety and Efficacy in a Large UK Cohort (ERS 2026) - "Conclusion Low-dose alteplase with DNase has potential cost-related benefits whilst remaining efficacious and safe in managing CPPEs. These findings support real-world use of low-dose IET regimens which would merit prospective study."

Clinical • Pleural effusion • Respiratory Diseases

Complex tuberculous pleural effusions and intrapleural enzyme therapy (ERS 2026) - "BackgroundIntrapleural Enzyme Therapy (IET) with alteplase and dornase-alpha is an established treatment for complex pleural infection...Given diagnostic uncertainty at presentation, we may be somewhat reassured IET does not cause harm in this population. Further prospective evaluation of IET in this cohort is needed."

Pleural effusion • Infectious Disease • Respiratory Diseases

Tailored intrapleural tPA/DNase therapy for pleural infection: A retrospective analysis of outcomes from a dedicated pleural service (ERS 2026) - "Intrapleural enzyme therapy (IET) treatment with alteplase (tPA) and dornase alfa (DNase), reduced the rate of surgical referral and duration of hospital stay in the MIST2 RCT...The length of stay is significantly skewed by a small number with extended hospital days, reflecting the significant morbidity associated with pleural infection. In appropriately selected patients, tPA/DNase is an effective treatment for pleural infection."

Retrospective data • Infectious Disease

Catheter-Directed Pulmonary Reperfusion in Treatment of Intermediate and High-Risk Pulmonary Embolism Patients and Its Impact on Pulmonary Artery Pressure (ERS 2026) - "Group 1: ST with intravenous alteplase infusion (90 mg) over 2 hours... novel SGC-guided LT in acute PE significantly improves pulmonary pressures, SI, and RV function, with fewer complications compared to traditional ST and other CDIs."

Clinical • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

REDSTEM: Reduced-Dose Versus Full-Dose Alteplase for High-Risk Pulmonary Embolism (clinicaltrials.gov) - P4 | N=400 | Not yet recruiting | Sponsor: Sahlgrenska University Hospital

New P4 trial • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Experience with Tenecteplase in Treatment of Acute Ischaemic Stroke in Window: Analysis and Outcomes at a Tertiary Care Institute in Central India. (PubMed, Ann Neurosci) - "Intravenous thrombolysis with alteplase has been the standard for acute ischaemic stroke (AIS) within 4.5 h, but tenecteplase (TNK) is gaining promising corner in intravenous thrombolysis with some unique features and superior efficacy in large vessel occlusion (LVO). TNK may be a better choice in resource-limited set-up. Multicentre trials are needed for its widespread adoption and also for its conjunctive use with mechanical thrombectomy."

Journal • Cardiovascular • Hypertension • Ischemic stroke

TENECTEPLASE VS ALTEPLASE IN MASSIVE PULMONARY EMBOLISM WITH SHOCK: A SEVEN- AND 14-DAY PROPENSITY SCORE-MATCHED ANALYSIS (CHEST 2026) - No abstract available

Cardiovascular • Pulmonary Embolism • Respiratory Diseases

SYSTEMIC ALTEPLASE USE IN PATIENTS WITH ACUTE PULMONARY EMBOLISM SUPPORTED WITH VENOARTERIAL ECMO: AN ELSO REGISTRY ANALYSIS (CHEST 2026) - No abstract available

Clinical • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Intravenous alteplase compared with standard medical treatment for stroke aged over 70 years: a secondary analysis of the HOPE randomised clinical trial. (PubMed, Stroke Vasc Neurol) - "This secondary analysis suggests that the evidence trends towards safety and effectiveness of intravenous alteplase in patients aged over 70 years during 4.5 to 24 hours after stroke onset."

Journal • Cardiovascular • Cerebral Hemorrhage • Ischemic stroke

Feasibility and safety of a standardized low-dose thrombolytic therapy for right-sided mechanical prosthetic valve thrombosis in adult congenital heart disease. (PubMed, Int J Cardiol Congenit Heart Dis) - "All patients received a standardized low-dose alteplase regimen (25 mg over 6 h)...During a median follow-up of 0.7 years, no recurrent valve thrombosis was observed. Standardized low-dose thrombolytic therapy was safe and feasible in this case series and may provide a non-surgical treatment option for ACHD patients with right-sided mechanical valve thrombosis."

Journal • Cardiovascular • Heart Failure • Hematological Disorders • Thrombosis

Impact of Emergency Medicine Pharmacist on Door-to-Needle Tenecteplase Time for Acute Ischemic Stroke. (PubMed, J Pharm Technol) - "Background: Emergency medicine pharmacist (EMP) involvement in stroke care has been associated with shorter door-to-needle (DTN) times of alteplase administration, which is crucial for optimizing outcomes in patients with acute ischemic stroke (AIS). An EMP at the bedside of patients presenting with AIS resulted in reduced DTN time with TNK administration. These findings support the role of bedside pharmacists in stroke response teams to improve efficiency and achieve time-sensitive treatment goals."

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

Extending the Treatment Window for Intravenous Thrombolysis in Acute Ischemic Stroke: An Updated Systematic Review and Meta-Analysis. (PubMed, Neurol Clin Pract) - "Among patients selected based on imaging, 4.5-24 hours after stroke onset/LKW, IVT improves outcomes despite an increased risk of sICH. TNK showed similar efficacy to alteplase, with a possible lower risk of sICH; however, direct comparisons in future trials are needed."

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

Early Recanalization After Tenecteplase or Alteplase in Distal and Medium Vessel Occlusion Strokes: An Observational Cohort Study. (PubMed, Stroke) - P | "Compared with alteplase, tenecteplase-treated patients with DMVO had higher early successful recanalization and a lower risk of substantial early infarct growth, supporting its preferential use in this setting. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05635786."

Journal • Observational data • Cardiovascular • CNS Disorders

Safety and efficacy of tenecteplase versus alteplase for acute ischemic stroke in a real-world patient population. (PubMed, Am J Emerg Med) - "There were no statistically significant differences in safety or efficacy between TNK and alteplase for AIS. These results provide real-world experience especially in a large, older patient population, with relatively minor stroke. Type II error may limit findings. Research is needed to identify patient, stroke, or fibrinolytic agent related factors that may increase bleeding occurrence."

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