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

Immunomodulation and Thrombolytic Approaches in the Management of Deep Vein Thrombosis and Pulmonary Embolism. (PubMed, Cardiol Cardiovasc Med) - "We critically evaluated and discussed the efficacy and risks associated with thrombolytic agents such as alteplase, reteplase, and tenecteplase, particularly in severe or hemodynamically unstable cases. In addition, we reviewed new and innovative approaches including immune-targeted therapies and nanoparticle-based drug delivery systems, which provide the promise of more precise, safer, and cost-effective interventions. By integrating immunologic insights with evolving thrombolytic strategies, this paper supports a more tailored approach to managing DVT and PE, with the goal of reducing recurrence, minimizing complications, and enhancing long-term patient outcomes."

Journal • Cardiovascular • Genetic Disorders • Hematological Disorders • Immunology • Inflammation • Pulmonary Embolism • Respiratory Diseases • Venous Thromboembolism

Pyoderma Gangrenosum Associated with Parathyroid Carcinoma: A Rare Case Report (EADV 2025) - "Materials & Methods A 33-year-old female with a history of chronic leg ulcers, clinically consistent with PG, was admitted due to methotrexate toxicity after mistakenly taking the medication daily...The patient was transferred to the intensive care unit and treated with thrombolysis using alteplase, resulting in clinical recovery and cardiac function improvement...Awareness of rare systemic triggers is essential for appropriate diagnostic workup and management of PG. Further reports and studies are needed to better understand the underlying pathophysiological mechanisms linking PG to solid organ malignancies."

Case report • Clinical • Cardiovascular • Endocrine Disorders • Febrile Neutropenia • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Inflammatory Bowel Disease • Metabolic Disorders • Neutropenia • Oncology • Pulmonary Embolism • Pyoderma Gangrenosum • Respiratory Diseases • Solid Tumor

Impact of Minimally Invasive Surgery on Midline Shift and Outcomes in Large Supratentorial Spontaneous Intracerebral Hemorrhage: Post Hoc Analysis of MISTIE III. (PubMed, Neurocrit Care) - "MIS for ICH significantly reduces MLS. This reduction in MLS significantly mediates reduction in 30-day mortality with MIS and is associated with both short-term and long-term outcomes."

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

Effectiveness and Safety of Reduced-Dose and Slow-Infusion Intravenous Tissue-Type Plasminogen Activator Regimen in Patients with Acute Pulmonary Embolism at Intermediate-High Risk. (PubMed, Anatol J Cardiol) - "Low-dose, slow-infusion t-PA therapy appears effective and well-tolerated, offering hemodynamic and clinical benefit with fewer bleeding complications in patients with IHR PE."

Journal • Cardiovascular • Hematological Disorders • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • TNNI3

SMAD-I: Synergistic Minimally Invasive Surgery Plus Alteplase and Deferoxamine in ICH (clinicaltrials.gov) - P1 | N=63 | Not yet recruiting | Sponsor: University of Illinois at Chicago

New P1 trial • Cerebral Hemorrhage • Hematological Disorders

Reversal of ischemic cortical blindness with tenecteplase. (PubMed, Am J Ophthalmol Case Rep) - "Tenecteplase (TNK) is a bioengineered variant of alteplase that has a longer half-life, a higher fibrin binding specificity, and a lower effect on systemic fibrinolytic activity. Clinicians should be aware of the various treatment options in acute ischemia related cortical visual loss such as TNK. Future providers should also add comprehensive ophthalmological exam before and after patient receiving TNK to determine if our case is generalizable."

Journal • Cardiovascular • Hematological Disorders • Ophthalmology

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

CHOICE2: CHemical OptImization of Cerebral Embolectomy 2 (CHOICE 2). (clinicaltrials.gov) - P3 | N=440 | Active, not recruiting | Sponsor: Hospital Clinic of Barcelona | Recruiting ➔ Active, not recruiting | Trial completion date: Aug 2025 ➔ Nov 2025 | Trial primary completion date: May 2025 ➔ Aug 2025

Enrollment closed • Trial completion date • Trial primary completion date • Cardiovascular • Ischemic stroke

Demographic and Premorbid Clinical Factors Predict Modified Rankin Score in Large and Medium Vessel Occlusion Ischemic Strokes. (PubMed, J Clin Med) - "Upon multivariate regression adjusted for race, age, hypertension, diabetes mellitus, radiologic features, IV alteplase, admission NIHSS, and reperfusion status, young age (p = 0.004), low admission NIHSS (p = 0.0001), and good reperfusion status (p = 0.007) were associated with good functional outcomes in LVO stroke... Known factors, including young age, low admission stroke severity, and successful reperfusion predict EVT outcomes in LVO stroke but not necessarily in MeVO stroke. Further studies regarding predictors of MeVO outcomes in nonsurgical cases, including collateral status, may guide optimal medical management for this population."

Journal • Cardiovascular • Diabetes • Hypertension • Ischemic stroke • Metabolic Disorders

SMAD-I: Synergistic Minimally Invasive Surgery Plus Alteplase and Deferoxamine in ICH (clinicaltrials.gov) - P2 | N=63 | Not yet recruiting | Sponsor: University of Illinois at Chicago | Phase classification: P1 ➔ P2 | Trial completion date: Dec 2026 ➔ Dec 2028 | Trial primary completion date: Dec 2026 ➔ Dec 2028

Phase classification • Trial completion date • Trial primary completion date • Cerebral Hemorrhage • Hematological Disorders

Predictors of Post-Alteplase Long-Term Unfavorable Outcome in Atrial Fibrillation Patients Presented with Embolic Stroke in the Middle East and North Africa Regions: A Multi-center, Longitudinal Study. (PubMed, Neurol Ther) - "Higher baseline NIHSS, heart failure, post-thrombolysis intracranial haemorrhage, and recurrent symptomatic stroke were independent predictors of long-term post-thrombolysis unfavorable functional outcome in embolic stroke patients. Novelly, higher HAS-BLED and CHA2DS2-VASc scores were independent predictors of long-term post-thrombolysis unfavorable functional outcome in Arabian patients. Moreover, sustained AF was an independent predictor of long-term post-thrombolysis unfavorable functional outcome."

Journal • Observational data • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Congestive Heart Failure • Heart Failure • Hematological Disorders • Ischemic stroke

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

Predictive Value of Combining Padua Score with D-Dimer for Deep Vein Thrombosis in Acute Ischemic Stroke Patients with Alteplase. (PubMed, Clin Lab) - "The combination of the Padua score and D-dimer levels can serve as an effective early warning tool for DVT in AIS patients treated with intravenous alteplase thrombolysis, thereby enhancing the early detection and management of DVT in this patient population."

Journal • Retrospective data • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombosis • Venous Thromboembolism

Catheter-Directed Bivalirudin for Local Anticoagulation and Clot Dissolution in Children Requiring Mechanical Circulatory Support. (PubMed, ASAIO J) - "In each case, direct bivalirudin delivery through a lysis catheter was associated with rapid resolution of thrombosis. Although study of more patients is needed to truly assess safety and efficacy, this series demonstrates that bivalirudin may be an effective drug for thrombolysis and should be considered in patients who have experienced bleeding or other complications from catheter-directed alteplase infusion."

Journal • Cardiovascular • Hematological Disorders • Thrombosis

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 • Pulmonary Disease • Rare Diseases • Respiratory Diseases

Impact of early versus delayed intrapleural fibrinolytics on pleural infection outcomes: an observational study (ERS 2025) - "2018 to Oct.2024, consecutive patients with pleural infections were included based on clinical signs (fever or raised inflammatory markers) and pleural fluid criteria (pH<7.2, gram stain positivity, or bacterial growth).All recieved drainage + fibrinolytics (Alteplase 10mg + DNase 5mg daily for up to 3 days).Group 1(pre-Nov...Further research is needed. Group 1 Group 2 p -value(95% CI) Mean Age(SD) 62(15.24) 59.66(17.44) Surgery in 3 months(%) 3(8.33) 1(1.694) 0.118 Mortality in 3 months(%) 2(5.55) 3(5.08) 0.921 Expected Mortality(RAPID score,%) 10.33% 12.5% 0.749 Hospital Stay(days,mean + SD) 10.92(13.17) 7.73(6.31) 0.1157(-0.80- 7.17) Chest tube duration(days,mean + SD) 6.20(4.32) 4.40(2.25) 0.0153(0.35- 3.24) Mean Antibiotic duration,days(SD) 19.78(14.49) 18.31(8.64) 0.535(-3.23- 6.18) Percent predicted FVC at 4 months (range) 90.5(49-126) 99.4(58-148) 0.031"

Clinical • Observational data • Infectious Disease

EVALUATION OF ALTEPLASE AND DORNASE ALFA FOR PREVENTION OF SURGICAL INTERVENTION FOR PATIENTS WITH EMPYEMA (CHEST 2025) - No abstract available

Clinical

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

Platelets loaded with alteplase exert fibrinolytic activity in human whole blood and plasma. (PubMed, Exp Hematol) - "The fibrinolytic activity of alteplase-loaded platelets was demonstrated in whole blood and plasma. Therefore, a drug DDS that employs alteplase-loaded platelets may offer a promising avenue for the development of a more biocompatible and less invasive thrombolytic therapy."

Journal • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • SELP

Trends and outcomes of tenecteplase and alteplase usage for ischemic stroke in the United States. (PubMed, Clin Neurol Neurosurg) - "Since 2022, the utilization of TNK for acute ischemic stroke in the US has increased significantly. TNK was associated with a higher likelihood of home discharge compared to alteplase. These findings support the use of TNK in clinical practice."

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

Therapeutic Potential of Lumbrokinase in Acute Ischemic Stroke: A Meta-Analysis of Efficacy and Safety. (PubMed, Ther Clin Risk Manag) - "Although alteplase is a standard thrombolytic therapy, its limited availability in low-resource settings presents a challenge...Laboratory assessments indicated improvements in aPTT (MD = 1.93; 95% CI: 1.58 to 2.28), platelet aggregation rate (MD = -205.86; 95% CI, -206.77 to -204.96), and D-dimer levels (MD = -0.04; 95% CI: -0.05 to -0.03). Lumbrokinase may safely improve stroke outcomes; however, limited evidence warrants cautious use and further high-quality trials."

Journal • Retrospective data • Review • Cardiovascular • Gastrointestinal Disorder • Ischemic stroke

PERIPHERAL ARTERIAL COMPLICATION ASSOCIATED WITH UPADACITINIB AND SEVERE ULCERATIVE PANCOLITIS: A CASE REPORT (UEGW 2025) - "Rescue infliximab (10 mg/kg) induction achieved partial initial clinical response, but no long term success...Endovascular revascularization included balloon angioplasty, intra-arterial nitrates, and alteplase thrombolysis...No further intervention was performed; rivaroxaban (2 × 2.5 mg) was added...Despite repeated colectomy recommendations, the patient declined and was transitioned to ustekinumab...Current evidence on the treatment and prevention of cardiovascular adverse events in IBD is limited, highlighting the need for further research. To our knowledge, this is the first reported case of such a complication."

Case report • Clinical • Cardiovascular • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Ulcerative Colitis

Predictors of Post-alteplase Hemorrhagic Transformation of Brain Infarction (clinicaltrials.gov) - P4 | N=600 | Completed | Sponsor: Kafrelsheikh University | Recruiting ➔ Completed

Trial completion • Cardiovascular • Hematological Disorders • Ischemic stroke

Serum Lipid Profiles as Predictors of Hemorrhagic Transformation After Thrombolysis in Acute Cerebral Infarction: A Prospective Study. (PubMed, Curr Neurovasc Res) - "Patients with ACI undergoing IVT who had higher baseline NIHSS scores, lower TC, higher HDL, and a higher T/H ratio were at increased risk of HT, which was also associated with long-term outcomes. The T/H ratio may be a valuable predictor of HT following IVT."

Journal • Cardiovascular • CNS Disorders • Hematological Disorders • Hypertension

A similar effect of fibrinogen on efficacy and safety of tenecteplase versus alteplase in acute ischemic cerebrovascular events (TRACE II) trial. (PubMed, J Transl Int Med) - "Similarly, there was no significant difference in mortality rates between patients treated with tenecteplase and alteplase across different plasma fibrinogen levels (interaction P = 0.58). The results of the study suggest that the efficacy and safety of tenecteplase in treated AIS patients within 4.5 h are comparable to those of alteplase, regardless of plasma fibrinogen levels."

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