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

Adjunctive intra-arterial thrombolysis after successful endovascular thrombectomy for large vessel occlusion: Meta-analysis of outcomes, dosage, and patient selection. (PubMed, J Neurointerv Surg) - "Adjunctive IA thrombolysis following successful EVT may improve functional outcomes without added risk of sICH. Certain patient subgroups (those with lower recanalization rates, higher NIHSS, and cardioembolic etiology) and specific thrombolytic agents and dosages (alteplase 0.225 mg/kg, tenecteplase 0.125 mg/kg) appear to derive greater benefits from this approach. Further research is needed to validate these findings and refine patient selection."

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

Treatment outcomes in pediatric empyema: a retrospective observational study from a tertiary center in Dubai, United Arab Emirates. (PubMed, Pediatr Surg Int) - "Prompt tube thoracostomy combined with intrapleural alteplase is a safe, effective, and resource-efficient first-line therapy for paediatric empyema, shortening hospital stay and markedly reducing the need for surgery."

Journal • Observational data • Retrospective data • Hematological Malignancies • Lymphoma • Oncology • Pediatrics

Group 5: beyond the norm: exploring unique profiles of high-risk PE, including the role of the mechanical circulatory system (ERS 2025) - "Learning objectives: a. Absolute and relative CI of tPA: pros and cons of tPA, including Alteplase vs Tenecteplase. c. Role of ECMO as a bridge to Sx or Percutaneous embolectomy."

Cardiovascular • Pulmonary Embolism • Respiratory Diseases

The dose of alteplase in massive pulmonary embolism: should it be individualized? (PubMed, Acute Crit Care) - No abstract available

Journal • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Case Report: Does extracorporeal membrane oxygenation treatment for acute pulmonary embolism-induced respiratory and cardiac arrest still require thrombolysis? (PubMed, Front Cardiovasc Med) - "Case 2 received immediate thrombolysis with alteplase 50 mg after ECMO cannulation but succumbed to severe bleeding complications-including cannulation site hemorrhage, disseminated intravascular coagulation (DIC), and hemorrhagic shock-within 24 h. For ECMO-treated PE patients with CA, clinical decisions should be based on etiological assessment, bleeding risk, and multimodal evaluations (e.g., imaging, coagulation function), prioritizing individualized reperfusion strategies (such as catheter-directed thrombectomy or surgical embolectomy) to improve prognosis. Although both cases described herein received VA-ECMO as salvage therapy, their divergent thrombolytic strategies resulted in contrasting clinical outcomes, prompting critical clinical reflections on risk-benefit balancing in this high-risk population."

Journal • Cardiovascular • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases

Comparing fibrinolytic strategies in intermediate-high-risk pulmonary embolism: Insights from a multicenter registry. (PubMed, Thromb Res) - No abstract available

Journal • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Letter to the editor, regarding "Transition from alteplase to tenecteplase for treatment of acute ischemic stroke in a rural stroke network of the Midwest: Planning, execution, safety, and outcomes" recently published by Loggini. (PubMed, Clin Neurol Neurosurg) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Lumbar extradural hematoma after labor analgesia in an anticoagulated patient, followed by a pulmonary embolism (Euroanaesthesia 2025) - "Enoxaparin was not resumed due to SH. Two days later she had a massive pulmonary embolism with cardio-respiratory arrest - 45min of advanced life support were performed with return of spontaneous circulation 15min after thrombolysis with alteplase 100mg...Anticoagulation increases SH risk after CNB. IVC filters are valuable options in complex cases."

Clinical • Back Pain • Cardiovascular • Fatigue • Genetic Disorders • Hematological Disorders • Musculoskeletal Pain • Obesity • Obstetrics • Pain • Pulmonary Embolism • Respiratory Diseases

Perioperative cardiac arrest and the chain of survival (Euroanaesthesia 2025) - "He was diagnosed with diabetic ketoacidosis (DKA), which resolved within 54 hours of treatment.He underwent an emergency arthroscopic washout for septic arthritis under general anaesthesia with Propofol and Alfentanil...A prolonged downtime of 90 minutes followed with ROSC achieved after two doses of Alteplase...Persistent bradycardia complicated by sepsis precluded pacing. He succumbed on day 37 due to multiple organ failure with sepsis, AKI and recurrent cardiac arrests contributing. This case highlights severe cardiovascular complications in poorly controlled diabetes exacerbated by emergency surgery and infection.Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality for diabetes patients."

Anesthesia • Atherosclerosis • Cardiovascular • Diabetes • Hypotension • Immunology • Infectious Disease • Metabolic Disorders • Myocardial Infarction • Orthopedics • Rheumatology • Septic Shock

Case of successful thrombolytic therapy during cardiopulmonary resuscitation in a pregnant women with massive pulmonary embolism (Euroanaesthesia 2025) - "Intensive care: NIV, dobutamine 5 mcg/kg/min and adrenaline 0.01 mcg/kg/min, morphine 1 mg, heparin: bolus 5000 U, followed by infusion of 1000 U/hour...Thrombolysis was performed 15 minutes after the onset of the first episode of asystole: alteplase 50 mg i.v. by jet stream, titrated with 50 mg at a rate of 25 mg/h, followed by heparin infusion (1000 U/h) in the postoperative period...CT with contrast was performed, massive pulmonary embolism with 60% lung involvement was established. The use of thrombolytic therapy during labor, on the one hand, is contraindicated, on the other hand, it is the only effective method of saving pulmonary embolism; the number of reports on thrombolytic therapy for massive PE in pregnant women is extremely small.Learning Points: Thrombolytic therapy provides excellent effect in case of circulatory arrest caused by PE in obstetric patients. It is advisable to manage hemocoagulation after thrombolytic therapy for PE with subsequent bleeding..."

Clinical • Cardiovascular • Obstetrics • Postpartum Hemorrhage • Pulmonary Embolism • Respiratory Diseases

The Role of Point of Care Ultrasound (POCUS) guided rescue thrombolysis in the management of postpartum pulmonary embolism with cardiac arrest in secondary care setting - the road between scylla and charybdis (Euroanaesthesia 2025) - "The patient received the recommended thrombolytic therapy using Alteplase...The patient developed multiorgan dysfunction that required critical care management, including renal replacement therapy and liver support, the patient recovered fully without neurological sequelae and was discharged home after 20 days. Thrombolytic therapy during CA due to PE has been increasingly reported, with several studies showing improved outcomes compared to conventional CPR alone (2). Studies have shown that applying POCUS during CPR aids in rapidly diagnosing the underlying causes, enabling targeted treatment (3)."

Cardiovascular • Heart Failure • Hematological Disorders • Infectious Disease • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

BEST-BAO: Direct Endovascular Treatment Versus Bridging Treatment In Basilar Artery Occlusive Stroke (clinicaltrials.gov) - P=N/A | N=340 | Recruiting | Sponsor: Sichuan Academy of Medical Sciences | Trial completion date: May 2027 ➔ Feb 2027

Trial completion date • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombosis

IA-SUCCESS: Intra-Arterial Thrombolysis After SUCCESSful Reperfusion in Anterior Circulation Ischemic Stroke (clinicaltrials.gov) - P3 | N=626 | Recruiting | Sponsor: Central Hospital, Nancy, France | Not yet recruiting ➔ Recruiting | Trial completion date: Mar 2029 ➔ Jul 2029 | Initiation date: Mar 2025 ➔ Jun 2025

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

PE-NORDIC: Reperfusion Treatment in Acute Pulmonary Embolism (clinicaltrials.gov) - P=N/A | N=220 | Recruiting | Sponsor: Sahlgrenska University Hospital

New trial • Cardiovascular • Pulmonary Embolism • Respiratory Diseases

Emergency anterior cerebral artery endarterectomy after mechanical thrombectomy failure: illustrative case. (PubMed, J Neurosurg Case Lessons) - "Microsurgical treatment is feasible for a challenging ACA occlusion with a severe calcified lesion in which an endovascular attempt is considered to be too difficult. This is the first case in which a favorable clinical outcome was reached with an emergency endarterectomy performed for A3 severe stenosis. https://thejns.org/doi/10.3171/CASE2596."

Journal • Atherosclerosis • Ischemic stroke

IMPACT AND PREDICTORS OF SERIOUS ADVERSE EVENTS IN ALTEPLASE COMPARED TO TENECTEPLASE TRIAL: A SECONDARY ANALYSIS (ESOC 2025) - "There were no differences in SAE incidence and type between tenecteplase and alteplase. SAEs were associated with worse functional outcomes regardless of intravenous thrombolytic type."

Adverse events • Serious adverse event • Cardiovascular • Ischemic stroke

TIME TO TREATMENT WITH INTRAVENOUS TENECTEPLASE BEFORE THROMBECTOMY AND FUNCTIONAL OUTCOMES IN ACUTE ISCHEMIC STROKE (ESOC 2025) - "Background and Aims: The benefit of intravenous thrombolysis (IVT) with alteplase plus thrombectomy vs thrombectomy alone has been shown to be time dependant. The benefit associated with intravenous tenecteplase plus thrombectomy vs thrombectomy alone may be time dependent and decrease with the time from symptom onset to expected administration of thrombolysis."

Cardiovascular • Ischemic stroke

INTRAVENOUS TENECTEPLASE FOR BASILAR ARTERY OCCLUSION: SYSTEMATIC REVIEW AND METANALYSIS (ESOC 2025) - "Tenecteplase is shown to be effective and safe in BAO and may be associated with an increased reperfusion rate compared to alteplase. Future randomized controlled trials comparing tenecteplase with alteplase in BAO are warranted."

Review • Cardiovascular • Ischemic stroke • Reperfusion Injury

THROMBOLYTIC TREATMENT OF PATIENTS WITH ACUTE ISCHAEMIC STROKE AND VERY HIGH BLOOD PRESSURE. (ESOC 2025) - "In patients with acute ischemic stroke, systolic blood pressure at baseline is related to occurrence of sICH, but no evidence exists for interaction with the effect of alteplase on sICH or functional outcome at 6 months."

Clinical • Cardiovascular • Hypertension • Ischemic stroke

EFFECTS OF INTRAVENOUS ALTEPLASE ADMINISTRATION ON SUBACUTE EDEMA EVOLUTION AFTER ACUTE ISCHAEMIC STROKE (ESOC 2025) - "There is a large oedema progression in the first week post-stroke. Statistical analysis showed a significant association between IVT and NWU progression within the first 24 hours from onset. However, statistical significance was lost after adjusting for confounders."

Cardiovascular • Ischemic stroke

DNASE I UNVEILS THE PRESENCE AND UNLOCKS THE THROMBOLYTIC POTENTIAL OF INTRAVENOUSLY-ADMINISTERED TPA IN LARGE VESSEL OCCLUSION ACUTE ISCHEMIC STROKE (ESOC 2025) - "A non-significant trend increased of thrombolysis was observed in tenecteplase- vs actilyse-treated patients. IVT achieves therapeutic tPA concentrations that are impaired by extracellular DNA. The findings support the use of DNase 1 as an adjuvant thrombolytic therapy to enhance IVT t-PA regimens."

Cardiovascular • Ischemic stroke • Thrombosis

FIBRINOGEN TIME COURSE IN ACUTE ISCHEMIC STROKE PATIENTS TREATED WITH INTRAVENOUS THROMBOLYSIS WITH ALTEPLASE VERSUS TENECTEPLASE (ESOC 2025) - "Fibrinogen depletion was observed only in AIS patients receiving alteplase and was associated with numerically higher rates of hemorrhagic complications. These findings require confirmation in larger, international prospective cohorts."

Clinical • Cardiovascular • Ischemic stroke

PENUMBRAL PERFUSION PATTERNS IN ACUTE ISCHEMIC STROKE WITH LARGE AND MEDIUM VESSEL OCCLUSION: A POST HOC ANALYSIS OF THE ACT TRIAL (ESOC 2025) - " In this post hoc analysis of the Alteplase compared to Tenecteplase (AcT) Trial, patients who underwent CTP and had either large vessel occlusion (LVO) or medium vessel occlusion (MeVO) were included. A favourable penumbral pattern is associated with a good clinical outcome for patients presenting within 4.5 h of symptom onset and LVO. However, a novel definition of the penumbral pattern is required in MeVO."

Retrospective data • Cardiovascular • Ischemic stroke

COST-EFFECTIVENESS OF THROMBECTOMY WITH OR WITHOUT ALTEPLASE FOR LARGE VESSEL OCCLUSION STROKE ACROSS 16 COUNTRIES: A META-ANALYSIS CONSIDERING TIME-TO-TREATMENT (ESOC 2025) - "Cost-effectiveness of alteplase plus thrombectomy varies per country and onset-to-IVT time. Combined treatment is cost-effective when IVT is administered within 140 minutes of symptom onset. The economic and clinical benefits of IVT plus thrombectomy diminish progressively with longer onset-to-IVT times, and become negative after 200 minutes."

Cost effectiveness • HEOR • Retrospective data • Cardiovascular

ASSESSING SAFETY AND CLINICAL OUTCOMES OF RINVECALINASE ALFA (DM199) IN ACUTE ISCHEMIC STROKE PATIENTS PRE-TREATED WITH INTRAVENOUS THROMBOLYTICS ONLY (ESOC 2025) - "Alteplase-treated patients required NIHSS assessment ≥1-hour post-reperfusion. Rinvecalinase alfa is generally safe and may benefit patients who received IVT and have residual neurologic deficits after IVT. These patients may have unsuccessful recanalization, artery reocclusion, artery-to-artery embolism, or no- reflow phenomenon, and may benefit from rinvecalinase alfa's potential to enhance collateral circulation and salvage penumbra."

Clinical • Clinical data • Cardiovascular • Ischemic stroke