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

Comparing the National Institutes of Health Stroke Scale Scores between emergency medicine physicians and neurologists for timely decision-making for alteplase administration. (PubMed, Turk J Emerg Med) - "There is high agreement between emergency medicine physicians and neurologists in the NIHSS evaluation and thrombolytic decisions for patients with acute ischemic stroke. According to our results, emergency medicine physicians can provide thrombolytic treatment in accordance with neurologists, thus shortening the time for thrombolytic treatment."

Journal • Cardiovascular • Ischemic stroke

Thrombolysis for Ischemic Stroke at 4.5 to 24 Hours: An Updated Meta-Analysis of Randomized Controlled Trials. (PubMed, J Stroke Cerebrovasc Dis) - "These findings suggest that IVT with tenecteplase or alteplase may enhance 90-day excellent outcomes in patients with late-window acute ischemic stroke without significantly increasing the risk of sICH or mortality."

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

Spurious Hyperphosphatemia From Alteplase-Treated Catheter: A Case Report and Literature Review. (PubMed, Clin Case Rep) - "Falsely elevated phosphate levels can occur when blood is drawn after alteplase use in dialysis catheters due to phosphorus-containing excipients. Recognizing spurious hyperphosphatemia is important to prevent misdiagnosis, avoid inappropriate treatment changes, and ensure accurate phosphate monitoring in patients undergoing maintenance hemodialysis."

Journal • Chronic Kidney Disease • Metabolic Disorders • Nephrology • Renal Disease

Efficacy and safety of 35 mg of recombinant human prourokinase for thrombolysis in acute ischemic stroke: a meta-analysis of randomized controlled trials. (PubMed, Int J Clin Pharm) - "This meta-analysis suggested that 35 mg of rhPro-UK does not significantly differ from 50 mg of rhPro-UK or alteplase in terms of clinical outcomes among AIS patients. However, the 35-mg dose of rhPro-UK has the potential advantages of enhancing early neurological recovery and reducing the risk of systemic bleeding. Subgroup analysis revealed that 35 mg of rhPro-UK might be associated with a lower risk of SAEs than 50 mg of rhPro-UK."

Journal • Retrospective data • Review • Cardiovascular • Ischemic stroke

Efficacy and Safety of Intravenous Thrombolysis Beyond 4.5 Hours in Ischemic Stroke: A Systematic Review and Meta-Analysis. (PubMed, Diagnostics (Basel)) - " IVT beyond 4.5 h improves neurological outcomes in patients with ischemic stroke without increasing overall mortality or systemic bleeding, though it raises the risk of sICH, any ICH, and type-II PH. Further large RCTs are needed to confirm these findings and guide clinical practice."

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

A simple scoring to predict symptomatic intracranial hemorrhage after stroke thrombolysis: the EGAN score. (PubMed, Neurol Res) - "With a cut-off point of 13, the EGAN score demonstrated good discrimination (0.7453 [95% CI: 0.649-0.841]), sensitivity (80.77%), and specificity (58.19%), respectively, for identifying sICH. This easy-to-use scoring model, based on predictors quickly obtained in clinical practices, offers a simple approach to screening for post-thrombolysis sICH and can serve as an alternative option in hospitals with limited resources for thrombolysis therapy."

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

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

FIVHeMA: Intraventricular Fibrinolysis for Aneurysmal Subarachnoid Hemorrhage. (clinicaltrials.gov) - P3 | N=81 | Terminated | Sponsor: University Hospital, Caen | N=440 ➔ 81 | Trial completion date: Mar 2024 ➔ Feb 2025 | Suspended ➔ Terminated; lack of patient

Enrollment change • Trial completion date • Trial termination • Cardiovascular • Hematological Disorders • Subarachnoid Hemorrhage

Effective removal of a large, mobile right atrial thrombus with the ŌNŌ retrieval device: a novel case report. (PubMed, Eur Heart J Case Rep) - "Thrombolysis with alteplase was initially attempted but was unsuccessful due to anaphylaxis...The novel ŌNŌ was effective in encapsulating the entire thrombus, securing fragments, and thereby reducing risk of embolization during retrieval. This approach also minimized blood loss and avoided the complications associated with invasive cardiothoracic surgery in a patient with underlying malignancy."

Journal • Cardiovascular • Hematological Malignancies • Hodgkin Lymphoma • Lymphoma • Oncology • Thrombosis

The efficacy and safety of tenecteplase versus alteplase in patients with myocardial infarction: a systematic review (ESC-WCC 2025) - No abstract available

Clinical • Review • Cardiovascular • Myocardial Infarction

How could ultraslow low-dose thrombolytic infusion regimes affect high thrombosis resolution rates in prosthetic valve thrombosis? (PubMed, Expert Rev Cardiovasc Ther) - "Ultraslow (25 hours) low-dose (25 mg) thrombolysis with Alteplase is a safe and effective first-line therapy for PVT patients, achieving high success in clot resolution while limiting bleeding and embolic complications. Ongoing evidence and mechanistic rationale suggest that, in the absence of contraindications, this strategy can often be preferable to traditional rapid high-dose thrombolysis or emergency surgery."

Journal • Review • Cardiovascular • Hematological Disorders • Thrombosis

Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study. (PubMed, Egypt Heart J) - "Thrombolytic therapy significantly improved oxygenation and clinical findings without major complications. Although mortality rates were lower in the thrombolytic group, the difference was not statistically significant. These results should be interpreted with caution, and larger prospective studies are needed to confirm the clinical efficacy and safety of thrombolytic therapy in this patient population."

Journal • Observational data • Cardiovascular • Hematological Disorders • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Mechanical Aortic Valve Thrombosis: Treatment With Tissue Plasminogen Activator. (PubMed, JACC Case Rep) - "Left heart catheterization revealed 100% occlusion of the distal left circumflex artery whereas cardiac computed tomography revealed a thrombus on the mechanical aortic valve. The patient was successfully treated with thrombolytic therapy using slow intravenous Alteplase infusion."

Journal • Cardiovascular • Hematological Disorders • Myocardial Infarction • Pain • Pulmonary Disease • Thrombosis

Clot Migration after Tenecteplase (TNK): A Potential Cause of Neurological Deterioration in Stroke Patients. (PubMed, Neurohospitalist) - "Tenecteplase (TNK) has been increasingly adopted as an alternative to alteplase (tPA) for ischemic stroke due to its ease of administration and pharmacologic advantages. Outcomes appear to depend on final clot location and clinical severity. As TNK becomes more widely used, increased awareness and early vascular imaging are critical for recognizing this phenomenon and guiding management."

Journal • Cardiovascular • CNS Disorders • Ischemic stroke • Thrombosis • Vascular Neurology

Faster Thrombolysis Is Associated With Improved Cognitive Outcomes in Patients With Acute Ischemic Stroke Treated With Alteplase and Tenecteplase: A Substudy of the AcT Trial. (PubMed, Stroke) - P3 | "Faster OTN time, with either alteplase or tenecteplase, was associated with higher T-MoCA scores and reduced the likelihood of impairment at 90 days. Faster thrombolytic treatment may reduce cognitive burden after stroke."

Clinical • Journal • Alzheimer's Disease • Cardiovascular • Cognitive Disorders • Ischemic stroke

Comparison of nicardipine versus labetalol for time to alteplase administration in acute ischemic stroke. (PubMed, Front Neurol) - "This study did not demonstrate a significant difference in time to alteplase administration between patients treated with labetalol vs. nicardipine. Further studies are needed to determine whether the choice of antihypertensive agent used in acute ischemic stroke significantly affects clinical outcomes."

Journal • Cardiovascular • Hypertension • Ischemic stroke • Myocardial Infarction

Comparative efficacy and safety of prourokinase versus alteplase for acute ischemic stroke within 4.5 hours: a systematic review and meta-analysis of randomized controlled trials. (PubMed, Neurol Res) - "However, concerns about cost and safety have led to an interest in alternative thrombolytics like prourokinase (rhPro-UK). Its advantages, including lower cost and ease of administration, make it a viable alternative. Future large-scale trials are recommended."

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

Current Understandings on Biological Characteristics of Thrombolytics in Acute Ischemic Stroke. (PubMed, Semin Thromb Hemost) - "Currently, alteplase and tenecteplase are approved thrombolytics for the treatment of acute ischemic stroke, whereas favorable outcomes of reteplase have recently been reported in a phase 3 clinical trial. In addition, plasmin activates mast cell degranulation (e.g., histamine release). Together, these biopharmacological data of thrombolytics promote insights into their clinical outcomes, and might provide comprehensive bases for future research."

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

Author reply to the letter 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". (PubMed, Clin Neurol Neurosurg) - No abstract available

Journal • Cardiovascular • Ischemic stroke

Computer-assisted vacuum aspiration mechanical thrombectomy with Lightning Flash allows broader clinical application, enhanced procedural safety, and improved clinical outcomes for the treatment of acute and subacute iliofemoral and central deep venous thrombosis. (PubMed, J Vasc Surg Cases Innov Tech) - "Alteplase was not used in any patient in this series...Eight-eight percent of patients maintained venous patency at their most recent follow-up range, 8-26 months). No perioperative pulmonary embolism or device-related complications were observed."

Clinical data • Journal • Cardiovascular • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases • Thrombosis

Impending arterial thrombosis in pediatric liver transplantation: Initial experience with alteplase - A case report. (PubMed, Int J Surg Case Rep) - "Thrombolytic therapy with alteplase is a possible and effective alternative in managing eHAT, particularly where conventional options are not indicated or limited."

Journal • Cardiovascular • Hematological Disorders • Hepatology • Pediatrics • Thrombosis • Transplantation

Rapid Onset of Massive Pulmonary Embolism After Knee Replacement: A Case of Obstructive and Cardiogenic Shock (ASA 2025) - "Despite thrombolytic therapy with alteplase and advanced hemodynamic management, the patient suffered recurrent pulseless electrical activity cardiac arrests and ultimately died. This case emphasizes the rapid progression and critical management challenges of postoperative pulmonary embolism in elderly surgical patients."

Clinical • Anesthesia • Cardiovascular • CNS Disorders • Epilepsy • Hypotension • Musculoskeletal Diseases • Orthopedics • Pulmonary Embolism • Respiratory Diseases

Severe Bronchospasm As A Manifestation of Acute Pulmonary Embolus (ASA 2025) - "Suspected bronchospasm was treated with epinephrine and albuterol. She progressed to PEA arrest and received CPR with ROSC after 15 minutes only after Alteplase (50 mg) was administered for suspected PE. Medically challenging case of resistant bronchospasm due to suspected acute pulmonary embolus; discussion of differential also includes bronchospasm due to reactive airway after burn injury and anaphylaxis due to rocuronium administration."

Pulmonary Embolism • Thermal Injury

A Novel Investigation of Risk Measurement and Mitigation in the Setting of Intrapleural Alteplase Administration in the Setting of Existing Thoracic Epidural: A Case Report (ASA 2025) - "Alteplase administration regardless of route is contraindicated in the setting of an existing thoracic epidural given the high risk for epidural hematoma formation. The pain service in conjunction with the ICU service was asked to provide recommendations to measure and limit risk associated with this procedure."

Case report • Clinical • CNS Disorders • Interstitial Lung Disease • Pain • Pulmonary Disease • Rare Diseases • Respiratory Diseases

Mechanical Mitral Valve Prosthesis Thrombosis: A Case Report. (PubMed, Acta Med Litu) - "Managing prosthetic valve thrombosis is challenging due to overlapping clinical features with other diagnoses and the lack of consensus on the treatment methods. Slow-infusion, low-dose thrombolytic therapy with alteplase can be a life-saving intervention with a high success rate."

Journal • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Respiratory Diseases • Thrombosis