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For more than a decade, intravenous tissue plasminogen activator (TPA) has been the only approved pharmacological treatment for acute ischemic stroke. Tenecteplase, an investigational drug, is a modified version of TPA with greater fibrin specificity and a longer half-life. Researchers conducted this randomized, phase IIB trial to compare standard TPA with two doses of tenecteplase (0.1 mg/kg or 0.25 mg/kg) for patients seen at one of three centers within 6 hours of stroke onset. Inclusion criteria were standard clinical criteria, a computed tomography (CT) perfusion deficit at least 20% greater than the infarct core, and CT angiography evidence of occlusion in the anterior, middle, or posterior cerebral arteries. The two primary endpoints …