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

Effect of intravenous alteplase before endovascular therapy for atherothrombotic stroke-related large vessel occlusion: subanalysis of the RESCUE AT-LVO registry. (PubMed, Stroke Vasc Neurol) - "In patients with AT-LVO, IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion. IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions."

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

Benefits of ESO stroke unit certification: A report from a Tertiary Stroke Center in Bucharest, Romania. (PubMed, Eur Stroke J) - "ESO Stroke Unit certification may lead to improved stroke care and patient outcomes, particularly in emerging healthcare systems."

Journal • Cardiovascular • Hematological Disorders • Ischemic stroke

Adjunctive intra-arterial thrombolysis following successful endovascular reperfusion in acute ischemic stroke: a systematic review and meta-analysis of seven randomized controlled trials. (PubMed, J Neurol) - "Adjunctive IAT following successful EVT in AIS-LVO patients led to improved 90-day excellent functional outcomes and reduced disability without increasing sICH or mortality risks."

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

Tenecteplase is here: navigating the shift of a stroke thrombolytic in the United States prior to FDA approval: a mini-review on rationale, barriers, and pathways. (PubMed, Front Neurol) - "The transition from alteplase (TPA) to tenecteplase (TNK) in acute ischemic stroke (AIS) management is gaining traction due to TNK's advantages in ease of administration and lower costs. The experience at Geisinger showcases a deliberate execution of a comprehensive change management strategy that resulted in successful and lasting outcomes. It may further serve as a blueprint for implementation of next generation thrombolytics yet to come."

FDA event • Journal • Review • Cardiovascular • Ischemic stroke

Blood-Brain Barrier Leakage in the Penumbra Is Associated With Infarction on Follow-Up Imaging in Acute Ischemic Stroke. (PubMed, Stroke) - P3 | "Of 503 patients enrolled in the trial, 165 with suitable dynamic susceptibility contrast-enhanced-MRI data were included in this analysis (mean age 66 years, 38% women, median National Institutes of Health Stroke Scale score of 6; 53% receiving alteplase)...URL: https://www.clinicaltrials.gov; Unique identifier: NCT01525290. Unique identifier: 2011-005906-32."

Journal • Cardiovascular • Hematological Disorders • Ischemic stroke

A Case Report of Drug-Induced Hemorrhagic Bullae. (PubMed, Clin Case Rep) - "Hemorrhagic bullae is a rare, non-immune, cutaneous adverse reaction that happens after the administration of some medicine. This case is a unique report of vancomycin and alteplase-induced hemorrhagic bullae and warns physicians and healthcare teams to take action properly."

Journal • Hematological Disorders

An International Survey on the Practice Patterns of Intrapleural Enzymatic Therapy for Complicated Parapneumonic Effusions and Empyema. (PubMed, Respir Med) - "This survey is the first to provide a descriptive analysis of current international practice patterns and variation in the management of CPPEs and empyema. There is a wide range of practice patterns among physicians. The choice of fibrinolytic, dose, dwell time, and number of days of treatment vary greatly."

Journal • Infectious Disease

Vitrectomy, subretinal Tissue plasminogen activator and Intravitreal Gas for submacular haemorrhage secondary to Exudative Age-Related macular degeneration (TIGER): update to study protocol and addition of a statistical analysis plan and health economic analysis plan for a randomised controlled surgical trial. (PubMed, Trials) - P3 | "In summary, there have been changes to three eligibility criteria: removing the word "Actilyse" from exclusion criterion 2, updating exclusion criterion 5 to state abstinence from heterosexual intercourse or the use of highly effective methods of birth control is mandatory for up to 12 weeks after last aflibercept exposure on trial, and clarifying exclusion criterion 6 relating to international normalised ratio (INR) is only applicable to participants receiving warfarin. The primary analysis of the trial as stated in the statistical analysis plan is the difference between groups in the proportion of participants gaining ≥ 10 ETDRS letters in their study eye at the month 12 visit, whilst the primary health economic analysis of the trial is the difference in quality-adjusted life years between groups at 12 months. ClinicalTrials.gov identifier: NCT04663750 ; EudraCT: 2020-004917-10."

Clinical protocol • HEOR • Journal • Age-related Macular Degeneration • Long-acting Reversible Contraceptives • Macular Degeneration • Ophthalmology • Retinal Disorders • Wet Age-related Macular Degeneration

Outcomes of systemic thrombolysis with reteplase in high-risk acute pulmonary embolism. (PubMed, J Basic Clin Physiol Pharmacol) - "Reteplase, as two bolus injections of 10 U given 30 min apart, is an effective thrombolytic regimen in treating acute high-risk PE with a low risk of major hemorrhagic complications."

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

CuratED: The emergency medicine pharmacotherapy literature of 2024. (PubMed, Am J Emerg Med) - "Covered topics include guideline updates on seizure prophylaxis in traumatic brain injury, corticosteroid use in sepsis and acute respiratory distress and antibiotic prophylaxis in trauma. Additional topics include updates on thrombolytic therapy for acute ischemic stroke, including tenecteplase versus alteplase, anticoagulation reversal strategies with andexanet alpha and prothrombin complex concentrate, and the use of tranexamic acid in traumatic brain injury, ketamine versus etomidate for intubation in critically ill adults, expert consensus on heart failure hospitalization management, geriatric emergency medication safety recommendations, and emerging data on dual antiplatelet therapy for stroke management."

Journal • Review • Acute Respiratory Distress Syndrome • Cardiovascular • CNS Disorders • Congestive Heart Failure • Epilepsy • Heart Failure • Infectious Disease • Ischemic stroke • Septic Shock • Vascular Neurology

PAEDIATRIC APHERESIS PROCEDURES USING HICKMAN CATHETERS: EXPERIENCE OF A UK CENTRE (EBMT 2025) - "Stem cell mobilisation was achieved by 5 days of pre-procedure administration of granulocyte colony stimulating factor (G-CSF) and only 5 patients (9%) required administration of plerixafor rescue for the second harvest procedure (expectation would be 10-20% in this cohort)...9 procedures had pressure alarms due to positional flow which were resolved with flushing the line, repositioning and alteplase administration, one procedure with clotting, resolved on changing tubing set and seven procedures (6%) were not completed due to positional flow (4), poor Hickman line function (2) or low CD34+ counts (1)... CUH runs a successful ASCT service with apheresis via Hickman catheters being successful in a significant majority of patients. Use of pre-existing Hickman catheters has been efficacious, safe, cost-effective, time-saving, and improves patient experience. National guidance on paediatric PBSC procedures via Hickman catheters would be beneficial to improve patient..."

Anesthesia • Bone Marrow Transplantation • Pediatrics • CD34

PAEDIATRIC APHERESIS PROCEDURES USING HICKMAN CATHETERS: EXPERIENCE OF A UK CENTRE (EBMT 2025) - "Stem cell mobilisation was achieved by 5 days of pre-procedure administration of granulocyte colony stimulating factor (G-CSF) and only 5 patients (9%) required administration of plerixafor rescue for the second harvest procedure (expectation would be 10-20% in this cohort)...9 procedures had pressure alarms due to positional flow which were resolved with flushing the line, repositioning and alteplase administration, one procedure with clotting, resolved on changing tubing set and seven procedures (6%) were not completed due to positional flow (4), poor Hickman line function (2) or low CD34+ counts (1)... CUH runs a successful ASCT service with apheresis via Hickman catheters being successful in a significant majority of patients. Use of pre-existing Hickman catheters has been efficacious, safe, cost-effective, time-saving, and improves patient experience. National guidance on paediatric PBSC procedures via Hickman catheters would be beneficial to improve patient..."

Anesthesia • Bone Marrow Transplantation • Pediatrics • CD34

Exploring the association between plasma lipids changes and embolization recurrence following intravenous thrombolysis with alteplase in acute ischemic stroke based on lipidomics. (PubMed, J Stroke Cerebrovasc Dis) - "This study demonstrates that lipid alterations, particularly in TG, DG, PC, and SM, may be associated with ER after alteplase treatment. However, further studies are needed to elucidate the exact mechanisms through which these lipids influence the onset and recovery of AIS."

Journal • Cardiovascular • Inflammation • Ischemic stroke • Metabolic Disorders

Correlation between systemic bleeding during thrombolysis and intracranial hemorrhage after thrombolysis in acute ischemic stroke. (PubMed, Expert Rev Neurother) - "Incorporating bleeding types increased Span-100 sensitivity to 0.623 and HAT to 0.648. Late-onset oral and other systemic bleeding during thrombolysis effectively predict HT in anterior circulation infarction, enhancing the sensitivity of Span100 and HAT scales when combined."

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

Risk of intracerebral haemorrhage with tenecteplase versus alteplase in acute ischaemic stroke: a meta-analysis. (PubMed, J Neurol) - "Our study provides the best evidence to date that TNK has a similar risk of ICH to ALT in AIS, with a very low incidence of symptomatic ICH, supporting that TNK has a good safety profile in terms of ICH."

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

Telemedicine-Enabled Ambulances for Prehospital Acute Stroke Management: A Pilot Study. (PubMed, Mayo Clin Proc Digit Health) - "Four patients (9%) received intravenous thrombolysis with alteplase (mean door to needle, 30.3 minutes), and 15 patients (32%) underwent mechanical thrombectomy (mean door to puncture, 72 minutes)...Telemedicine-enabled ambulances in emergency medical services systems are novel, feasible, and potentially scalable options for evaluating patients with suspected acute stroke in the prehospital setting. However, optimization of infrastructure, staffing models, and internet connectivity is necessary, and larger studies evaluating the clinical and cost effectiveness of this approach are needed before widespread implementation."

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

Tenecteplase compared to alteplase before mechanical thrombectomy enhances 1-h recanalization and reduces disability in large-vessel occlusion. (PubMed, J Neurol) - "Real-world observations reveal tenecteplase has increased ER rates compared to alteplase within 1 h of IVT and reduced disability in LVO patients. Further randomized trials are warranted to evaluate the effect of tenecteplase rapid bridging mechanical thrombectomy."

Journal • Cardiovascular • Thrombosis • ER

Dual Antiplatelet Therapy versus Intravenous Thrombolysis for Patients with Acute Minor Ischaemic Stroke: A Systematic Review and Meta-analysis (P9-13.009). (PubMed, Neurology) - "Although the effectiveness of intravenous alteplase in treating AMIS remains uncertain due to limited clinical data, dual antiplatelet therapy, using clopidogrel and aspirin, has been shown to reduce the risk of recurrent strokes without significantly increasing the risk of hemorrhage. Dr. Alam has nothing to disclose."

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

Comparison of Hemorrhagic and Non-Hemorrhagic Access-Site Complications with Tenecteplase vs Alteplase Bridging Thrombolysis Prior to Stroke Thrombectomy (P5-13.009). (PubMed, Neurology) - "Dr. Hendrix has nothing to disclose."

Clinical • Journal • Retrospective data • Atrial Fibrillation • Cardiovascular • Coronary Artery Disease • Hematological Disorders

Intracranial and Extracranial Systemic Complications with Alteplase vs Tenecteplase among Large Vessel Occlusion Stroke Patients Undergoing Thrombectomy (P7-13.013). (PubMed, Neurology) - "Dr. Hendrix has nothing to disclose."

Clinical • Journal • Retrospective data • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Ischemic stroke • Subarachnoid Hemorrhage

Contrast-Induced Cerebritis Leading to Acute Hemiparesis (P8-14.001). (PubMed, Neurology) - "The patient was taken for conventional angiogram of the right carotid artery and received 4 mg intra-arterial IV alteplase to the right ophthalmic artery for central retinal artery occlusion...The patient was started on intravenous fluids and Decadron 4 mg every 6 hours...Dr. Farooq has nothing to disclose."

Journal • Cardiovascular • CNS Disorders • Dyslipidemia • Epilepsy • Hematological Disorders • Hypertension • Inflammation • Metabolic Disorders • Ophthalmology • Pain • Retinal Disorders

HOCUS POCUS: A THROMBUS HAS DISAPPEARED - Juan A. Rodríguez Carbonell (ACC 2025) - "We conclude that ultra-slow, ultra-dose thrombolytic therapy is effective and safe for the treatment of a giant intraatrial thrombus. Hocus pocus, a thrombus has disappeared, with a touch of alteplase, life has reappeared."

Dyslipidemia • Hypertension • Metabolic Disorders • Thrombosis

USE OF PERCUTANEOUS RVAD MECHANICAL CIRCULATORY SUPPORT IN THE MANAGEMENT OF HIGH-RISK PE LEADING TO OBSTRUCTIVE SHOCK WITH SEVERE RV FAILURE AND CARDIAC ARREST - Dalton Delaney (ACC 2025) - "Despite Alteplase, patient had worsening hypotension with recurrent episodes of cardiac arrests, requiring the initiation of four pressors and dobutamine for stabilization. This case report shows that percutaneous RVAD-MCS placement can be a safe and effective modality for management of complicated high-risk PE leading to obstructive shock with severe RV failure and cardiac arrest."

Acute Kidney Injury • Cardiovascular • Hypotension • Metabolic Disorders • Pulmonary Embolism • Renal Disease • Respiratory Diseases

BIOPROSTHETIC AORTIC VALVE THROMBOSIS TREATED WITH INTRAVENOUS THROMBOLYTIC THERAPY: A UNIQUE CASE REPORT - Muhammad Hammad Sharif (ACC 2025) - "Due to high surgical risk, surgery was deemed inappropriate and she was started on an ultraslow infusion of alteplase of 1 mg/hr for 25 hours followed by serial TTE to assess valve hemodynamics and thrombosis resolution... BPVT after TAVR is a known and serious complication that can lead to cardiogenic shock. Thrombolysis is an effective treatment strategy, especially in patients with higher surgical risk. Ultraslow tPA infusion has a good efficacy and safety profile."

Case report • Clinical • Cardiovascular • Hematological Disorders • Pulmonary Disease • Thrombosis

UNLOCKING THE VALVE: SUCCESSFUL THROMBOLYSIS IN HIGH-RISK PATIENTS - Iván Arcadio Ovalles Brito (ACC 2025) - "The patient was discharged with no symptoms and reinforced warfarin dosing. This case illustrates that thrombolysis with alteplase is a viable and effective treatment for high-risk surgical patients with MMVT. This case illustrates that thrombolysis with alteplase is a viable and effective treatment for high-risk surgical patients with MMVT. Several studies have demonstrated its efficacy, highlighting reduced complications, shorter hospital stays, and improved survival rates, especially with the ultra-slow infusion protocol. Further refinement and dissemination of these therapeutic approaches are recommended to optimize outcomes in high-risk patients."

Clinical • Cardiovascular • Hematological Disorders • Respiratory Diseases • Thrombosis