Novel thrombolytic agents for acute ischemic stroke: A comprehensive review of current evidence

IF 3.2 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Neurological Sciences Pub Date : 2025-08-11 DOI:10.1016/j.jns.2025.123653

Julian Frederic Hotz , Lisa Kaindl , Stefan Krebs , Sven Poli , Jan Purrucker , Daniel Strbian , Stefan Greisenegger , Marek Sykora

{"title":"Novel thrombolytic agents for acute ischemic stroke: A comprehensive review of current evidence","authors":"Julian Frederic Hotz , Lisa Kaindl , Stefan Krebs , Sven Poli , Jan Purrucker , Daniel Strbian , Stefan Greisenegger , Marek Sykora","doi":"10.1016/j.jns.2025.123653","DOIUrl":null,"url":null,"abstract":"<div><div>Intravenous thrombolysis is one of the standard treatments of acute ischemic stroke. Over the last decades, alteplase (recombinant tissue type plasminogen activator, rt-PA) has been established as the main thrombolytic agent worldwide. However, the short plasma half-life of rt-PA poses logistical challenges, as it necessitates administration as a 10 % bolus followed by a 90 % infusion over one hour. These logistical difficulties, combined with the search for agents with improved efficacy and safety profiles, have spurred the development of alternative thrombolytic agents. This review summarizes current clinical evidence and emerging research on novel thrombolytic agents in acute ischemic stroke, including tenecteplase, reteplase, desmoteplase, urokinase, staphylokinase, JX10, LT3100, Ancrod, and TS23. Among these agents, tenecteplase has been most extensively studied and is already recommended for selected indications by the European Stroke Organization (ESO) and the American Heart Association and American Stroke Association (AHA/ASA). Other agents are still undergoing early clinical investigation and show different levels of potential in terms of effectiveness, safety, and ease of administration.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123653"},"PeriodicalIF":3.2000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Neurological Sciences","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022510X25002734","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Intravenous thrombolysis is one of the standard treatments of acute ischemic stroke. Over the last decades, alteplase (recombinant tissue type plasminogen activator, rt-PA) has been established as the main thrombolytic agent worldwide. However, the short plasma half-life of rt-PA poses logistical challenges, as it necessitates administration as a 10 % bolus followed by a 90 % infusion over one hour. These logistical difficulties, combined with the search for agents with improved efficacy and safety profiles, have spurred the development of alternative thrombolytic agents. This review summarizes current clinical evidence and emerging research on novel thrombolytic agents in acute ischemic stroke, including tenecteplase, reteplase, desmoteplase, urokinase, staphylokinase, JX10, LT3100, Ancrod, and TS23. Among these agents, tenecteplase has been most extensively studied and is already recommended for selected indications by the European Stroke Organization (ESO) and the American Heart Association and American Stroke Association (AHA/ASA). Other agents are still undergoing early clinical investigation and show different levels of potential in terms of effectiveness, safety, and ease of administration.

查看原文本刊更多论文

急性缺血性卒中的新型溶栓剂：当前证据的综合回顾

静脉溶栓是急性缺血性脑卒中的标准治疗方法之一。在过去的几十年里，阿替普酶（重组组织型纤溶酶原激活剂，rt-PA）已被确立为世界范围内主要的溶栓药物。然而，rt-PA的血浆半衰期短带来了后勤方面的挑战，因为它需要在一小时内以10%的剂量给药，然后输注90%。这些后勤方面的困难，再加上寻找疗效和安全性更高的药物，促使了替代溶栓药物的发展。本文综述了急性缺血性卒中中新型溶栓药物的临床证据和新研究，包括替奈普酶、雷替普酶、去氨替普酶、尿激酶、葡萄激酶、JX10、LT3100、anrod和TS23。在这些药物中，tenecteplase的研究最为广泛，并已被欧洲卒中组织（ESO）、美国心脏协会和美国卒中协会（AHA/ASA）推荐用于特定适应症。其他药物仍在进行早期临床研究，在有效性、安全性和给药方便性方面显示出不同程度的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the Neurological Sciences 医学-临床神经学

CiteScore

7.60

自引率

2.30%

发文量

313

审稿时长

22 days

期刊介绍： The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.