Lower-Dose Tenecteplase Still Optimal Before Ischemic-Stroke Intervention

In patients with large-vessel occlusion ischemic stroke, 0.25-mg/kg tenecteplase remains preferable before planned endovascular thrombectomy.

Thrombolysis is standard treatment within 4.5 hours after acute ischemic stroke. A subset of patients who have a large-vessel occlusion (LVO) receive thrombolysis before endovascular thrombectomy (EVT) is attempted. In an Australian study of patients evaluated for EVT, the reperfusion rate was significantly higher with tenecteplase than alteplase (NEJM JW Neurol May 22 2018 and N Engl J Med 2018; 378:1573).

The authors of that study have now conducted a randomized trial comparing two tenecteplase dosing regimens — intravenous bolus of 0.25 mg/kg or 0.40 mg/kg — in adults who presented within 4.5 hours after LVO ischemic stroke and had EVT planned. At baseline, the 300 participants (mean age, 73 years; 47% women) had a median NIH Stroke Scale…

Reviewing Author

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Lower-Dose Tenecteplase Still Optimal Before Ischemic-Stroke Intervention

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Reviewing Author