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

Impact of low-dose alteplase bridging therapy on outcomes after mechanical thrombectomy in patients with atrial fibrillation-associated acute stroke: A retrospective cohort study. (PubMed, Medicine (Baltimore)) - "In adjusted models, low-dose bridging predicted 90 day independence (odds ratio 1.68) and lower odds of symptomatic hemorrhage than standard-dose (odds ratio 0.48). Low-dose alteplase bridging before thrombectomy improved efficacy and safety in atrial fibrillation related large vessel occlusion stroke and may be preferable for patients at higher bleeding risk."

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

Timing matters: early antiplatelet therapy optimizes alteplase treatment in acute ischemic stroke. (PubMed, Ann Med) - "Subgroup analyses indicated that aspirin was the primary contributor to the observed benefits. Initiating APT within 24 h after alteplase improves neurological and functional recovery in AIS without increasing hemorrhagic risk. These findings suggest that earlier APT may be considered in post-thrombolysis management, potentially informing revisions to current guideline recommendations."

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

Systemic Thrombolytic Resistance in Antithrombin III Deficiency Rescued by Catheter-Directed Thrombolysis: A Case Report. (PubMed, Catheter Cardiovasc Interv) - "This case highlights systemic thrombolysis failure associated with AT III deficiency and demonstrates that CDT can serve as an effective, low-bleeding-risk rescue therapy for extensive DVT when systemic treatment is inadequate. These findings underscore the importance of early recognition of AT III deficiency and consideration of catheter-based intervention in similar high-risk settings."

Journal • Cardiovascular • Hematological Disorders • Pulmonary Disease • Pulmonary Embolism • Thrombosis

REVISION: Early Reperfusion Therapy With Intravenous Thrombolysis for Recovery of VISION in Acute Central Retinal Artery Occlusion (clinicaltrials.gov) - P3 | N=422 | Active, not recruiting | Sponsor: University Hospital Tuebingen | Recruiting ➔ Active, not recruiting

Enrollment closed • Retinal Disorders

P160924: PEITHO-3 - A reduced dose of thrombolytic treatment for patients with intermediate high-risk acute pulmonary embolism: a randomized controlled trial (clinicaltrialsregister.eu) - P2/3 | N=760 | Active, not recruiting | Sponsor: Assistance Publique Hopitaux De Paris | Recruiting ➔ Active, not recruiting

Enrollment closed • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Timing-Dependent Cleavage of Interleukin-1 Receptor Antagonist by Alteplase Impairs Neuroprotection in Ischemic Stroke. (PubMed, Stroke) - "These studies confirm a negative interaction between the 2 drugs, which can be prevented by tPA preceding IL-1Ra treatment. The findings raise broader concerns about how tPA may interfere with other neuroprotective treatments."

Journal • Cardiovascular • Inflammation • Ischemic stroke

Pulmonary Embolism: Response to Alteplase, Catheter-Directed Thrombolysis, and Thrombectomy (SCCM 2026) - "This study found increased risk of mortality with systemic thrombolysis compared to MT or CDT with no difference in ICU LOS or major bleeding. Results should be interpreted as exploratory due to higher number of patients in the systemic thrombolysis cohort considered to have high-risk PE. Providers should consider the risks and benefits of systemic thrombolysis, CDT, and mechanical thrombectomy."

Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Clots Unraveled: Strategies to Optimize Pulmonary Embolism Management (SCCM 2026) - "This session will describe strategies and updated evidence on the efficacy of pulmonary embolism response teams, catheter-directed thrombolytics, and optimization of thrombolytic selection and dosing related to the management of acute massive and submassive pulmonary embolism.Learning Objectives: • Evaluate the benefits of institutional pulmonary embolism response (PERT) teams on patient outcomes • Appraise the evidence for tenecteplase and alteplase for acute thrombolysis in the setting of pulmonary embolism • Discuss safety, efficacy, and indications for catheter-directed thrombolysis Learning Objectives: • Evaluate the benefits of institutional pulmonary embolism response (PERT) teams on patient outcomes • Appraise the evidence for tenecteplase and alteplase for acute thrombolysis in the setting of pulmonary embolism • Discuss safety, efficacy, and indications for catheter-directed thrombolysis"

Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Transesophageal Echocardiogram for the Diagnosis of Massive Cardiac Embolism During Liver Transplant (SCCM 2026) - "Ultra-low-dose alteplase (1 mg) was then given with remarkable improvement in intraoperative hemodynamics, though significant transfusion was required after...Given the intraoperative setting, there is not a suitable alternative to TEE for confidently establishing this diagnosis, and even a pulmonary artery catheter does not provide a similar degree of confidence without considerable diagnostic ambiguity. TEE use during OLT anesthesia can be analogized to rescue TEE in general, where a minimal number of TEE views prove the necessary information to rapidly and systematically establish a working diagnosis in undifferentiated shock or cardiac arrest."

Cardiovascular • Heart Failure • Transplantation

Thrombectomy With Alteplase or Tenecteplase: Comparative Analysis From TriNetX Realworld Data (SCCM 2026) - "Among patients with AIS-LVO undergoing MT, receiving tPA was associated with a similar risk of hemorrhagic stroke or major bleeding. However, receiving tPA was associated with higher risk of transfusion. Further studies are necessary to confirm the efficacy of TNK versus tPA"

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

Safety and Efficacy of Alteplase Versus Tenecteplase for Acute Ischemic Stroke (SCCM 2026) - "There were no statistically significant differences in safety or efficacy outcomes between alteplase and TNK use for patients with AIS. These results provide real-world experience in a large, older population, with minor stroke. It is possible type II error may be limiting these findings."

Clinical • Cardiovascular • Ischemic stroke

Evaluating the Safety and Efficacy of Alteplase Versus Tenecteplase in Acute Ischemic Stroke (SCCM 2026) - "This study found no difference between tPA and TNK in door-to-needle times or secondary safety and efficacy outcomes including incidence of angioedema, rate of symptomatic hemorrhagic conversion, mRS at discharge/90 days, or rate of successful reperfusion. These results suggest that TNK is a safe and effective alternative thrombolytic to tPA for the management of acute ischemic stroke."

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

A New Large Vessel Occlusion Occurring One Hour After the Administration of Tenecteplase (SCCM 2026) - "Introduction: Early recurrent ischemic stroke (ERIS) after IV thrombolytic therapy is rare. Case reports describing END following IV thrombolysis only describe the use of alteplase. This case brings to light the risk of thromboembolism associated with TCM and ERIS following TNK administration."

Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Ischemic stroke

Evaluation of Daily Intrapleural Alteplase and Dornase Alfa for Complicated Parapneumonic Effusions (SCCM 2026) - "Once-daily intrapleural tPA and DNase demonstrated comparable rates of surgical intervention to those observed in the MIST-2 trial. Notably, this regimen was associated with fewer significant adverse events and may offer potential cost savings. These findings support the viability of a once-daily dosing strategy in the management of complicated parapneumonic pleural effusions."

Respiratory Diseases

Labetalol vs Labetalol/Nicardipine for Hypertension in Acute Stroke Prior to Thrombolytic Therapy (SCCM 2026) - "Introduction: Blood pressure (BP) control prior to and after administration of either tenecteplase or alteplase (TNK/tPA) for acute ischemic stroke (AIS) is essential to ensure timely administration of therapy and minimize adverse events. Effective BP control is important in AIS to reduce the time to TNK/tPA administration and adverse events. Overall, time to BP < 185/110 mmHg was not different between groups. However, when more than one dose of labetalol is needed to achieve eligibility for thrombolytic therapy, early initiation of nicardipine may reduce the time to goal blood pressure."

Cardiovascular • Hypertension • Ischemic stroke

Hemorrhagic Transformation Rates of Alteplase Versus Tenecteplase in Acute Ischemic Stroke (SCCM 2026) - "Symptomatic, asymptomatic, and petechial hemorrhagic transformation rates were comparable between alteplase and tenecteplase in the treatment of AIS, consistent with findings from prior major clinical trials."

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

Treating the Trifecta: Central Venous Catheter Injury, Entrapped Lung, and Pneumothorax Ex Vacuo (SCCM 2026) - "Intrapleural alteplase was administered for the decreased chest tube output...Entrapped lung if left untreated might lead to symptoms, PEV, fluid re-accumulation, trapped lung and fibrothorax. In our case, early VATS was done for clotted hemothorax after incomplete evacuation with chest tubes and intrapleural fibrinolytics."

Cardiovascular • Glomerulonephritis • Hematological Disorders • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Metabolic Disorders • Nephrology • Respiratory Diseases • Thrombosis

Safety and Duration of Intrathecal Alteplase via IRRAflow for Intraventricular Hemorrhage (SCCM 2026) - "Given the low incidence of clinically significant hemorrhagic expansion, infection, catheter occlusion, and replacement, continuous IT alteplase via IRRAflow should be considered safe. The observed rate of hemorrhage expansion was lower than what has been reported in the literature with traditional EVDs. To our knowledge, this is the largest retrospective cohort study of alteplase administration via IRRAflow, supporting its potential role in the management of intraventricular hemorrhage."

Clinical • CNS Disorders • Hematological Disorders • Infectious Disease • Ventriculomegaly

HEART VALVE TEAM APPROACH TO RECURRENT PROSTHETIC MITRAL VALVE THROMBOSIS: INTEGRATING FIBRINOLYSIS AND SURGERY (ACC 2026) - "She underwent ultraslow alteplase infusion (1 mg/hr; 80 mg total) with partial gradient reduction (to 9 mmHg), but persistent leaflet restriction... This case illustrates the limitations of fibrinolysis in organized or recurrent PVT and the importance of heart valve team approach. While slow-infusion fibrinolysis achieves high success in select patients, surgery remains definitive when obstruction persists. Recent data, including the HATTUSHA trial, support fibrinolysis as effective with fewer complications than surgery, but recurrence underscores the need for strict anticoagulation and individualized management."

Surgery • Cardiovascular • Hematological Disorders • Pulmonary Disease • Thrombosis

INTRAPERICARDIAL FIBRINOLYSIS WITH ALTEPLASE AND DORNASE ALFA FOR LOCULATED PURULENT EFFUSION: A NOVEL THERAPEUTIC APPROACH (ACC 2026) - "This case demonstrates successful use of intrapericardial fibrinolysis as a rescue strategy for refractory loculated purulent pericardial effusion in a nonsurgical candidate. Further study is warranted to define efficacy, safety, and dosing protocols."

Cardiovascular • Infectious Disease • Septic Shock

ELUSIVE MECHANICAL VALVE THROMBOSIS NECESSITATING ADVANCED IMAGING AND FIBRINOLYSIS (ACC 2026) - "Due to surgical complication risk for re-operation, received serial low dose alteplase with resolution of valve thrombosis... We show a case of MVT with normal leaflet motion treated with fibrinolytics outside the scope of standard guidelines"

Metastases • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Hematological Malignancies • Hodgkin Lymphoma • Lymphoma • Pulmonary Disease • Respiratory Diseases • Thrombosis

PROSTHETIC VALVE THROMBOSIS IN A COMPLEX CONGENITAL HEART DISEASE PATIENT: MULTIMODALITY DIAGNOSIS AND LOW-DOSE, ULTRA-SLOW THROMBOLYTIC THERAPY (ACC 2026) - "Due to elevated surgical risk from multiple prior sternotomies, ultraslow low-dose alteplase infusion (1 mg/h for 25 hours) was administered, followed by intravenous heparin. This case highlights the efficacious use of ultraslow low-dose thrombolysis in managing mechanical aortic PVT in a surgically high-risk patient. Multimodality imaging and Heart Team collaboration, as emphasized in current guidelines, are pivotal for optimizing therapeutic strategies and outcomes."

Clinical • Cardiovascular • Heart Failure • Hematological Disorders • Pulmonary Disease • Thrombosis

EFFICACY AND SAFETY OF AN ALTEPLASE PURGE SOUTION FOR TREATMENT OF SUSPECTED THROMBOSIS OF PERCUTANEOUS MICROAXIAL FLOW PUMP VENTRICULAR ASSIST DEVICES (ACC 2026) - "Conclusions to be made once data is analyzed and interpreted."

Clinical • Cardiovascular • Hematological Disorders • Thrombosis

A RARE CASE OF CONCURRENT PULMONARY ARTERIAL AND VENOUS THROMBOSIS IN A YOUNG FEMALE (ACC 2026) - "Alteplase was infused at 1 mg/hour per catheter with serial fibrinogen monitoring... Concurrent PE and PVT is a rare and life-threatening condition. Catheter-directed thrombolysis is a safe and effective treatment that may address both arterial and venous thrombi."

Clinical • Cardiovascular • CNS Disorders • Epilepsy • Hematological Disorders • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Thrombosis

STANDARD-DOSE TENECTEPLASE VS ALTEPLASE IN ST-ELEVATED MYOCARDIAL INFARCTION: A DOSE-STRATIFIED BAYESIAN NETWORK META-ANALYSIS OF RANDOMIZED TRIALS (ACC 2026) - "These findings provide clinically relevant evidence to inform future guideline updates and support the use of standard-dose TNK as a practical reperfusion option."

Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Myocardial Infarction