ATTESTing to the Importance of Patient Selection: Tenecteplase for Acute Stroke

Tenecteplase, a genetically modified version of human tissue plasminogen activator (alteplase), is more selective than alteplase for the fibrin in blood clots and is more resistant to endogenous inactivation. Therefore, tenecteplase is administered as a single 5- to 10-second intravenous bolus, rather than the hour-long infusion that is required for alteplase.

A previous dose-finding randomized trial of tenecteplase for stroke within 3 hours was terminated for slow recruitment, but a more recent randomized trial of 75 stroke patients with large-artery occlusion that were selected using computed tomography (CT) perfusion and treated within 6 hours reported better outcomes for tenecteplase compared with alteplase.

Now, researchers have evaluate…