急性缺血性卒中患者的替奈普酶与阿替普酶：随机对照试验的最新荟萃分析

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-03-27 DOI:10.1016/j.jstrokecerebrovasdis.2025.108300

Maheen Sheraz MBBS , Nawal Asif MBBS , Ariba Khan MBBS , Muhammad Khubaib Khan MBBS , Muhammad Maaz Bin Rehan MBBS , Muhammad Tayyab Amer Ch MBBS , Ahmed Sadain Khalid MBBS , Caterina Oriana Alfieri MBBCh BAO , Elmehdi Bouyarden MD , Mohamed Amine Ghenai MD , Ahmad Alareed MBBS, MRCP , Raheel Ahmed MRCP , Mushood Ahmed MBBS , Muhammad Ehsan MBBS

{"title":"急性缺血性卒中患者的替奈普酶与阿替普酶：随机对照试验的最新荟萃分析","authors":"Maheen Sheraz MBBS , Nawal Asif MBBS , Ariba Khan MBBS , Muhammad Khubaib Khan MBBS , Muhammad Maaz Bin Rehan MBBS , Muhammad Tayyab Amer Ch MBBS , Ahmed Sadain Khalid MBBS , Caterina Oriana Alfieri MBBCh BAO , Elmehdi Bouyarden MD , Mohamed Amine Ghenai MD , Ahmad Alareed MBBS, MRCP , Raheel Ahmed MRCP , Mushood Ahmed MBBS , Muhammad Ehsan MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108300","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs).</div></div><div><h3>Results</h3><div>A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14).</div></div><div><h3>Conclusion</h3><div>In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108300"},"PeriodicalIF":2.0000,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials\",\"authors\":\"Maheen Sheraz MBBS , Nawal Asif MBBS , Ariba Khan MBBS , Muhammad Khubaib Khan MBBS , Muhammad Maaz Bin Rehan MBBS , Muhammad Tayyab Amer Ch MBBS , Ahmed Sadain Khalid MBBS , Caterina Oriana Alfieri MBBCh BAO , Elmehdi Bouyarden MD , Mohamed Amine Ghenai MD , Ahmad Alareed MBBS, MRCP , Raheel Ahmed MRCP , Mushood Ahmed MBBS , Muhammad Ehsan MBBS\",\"doi\":\"10.1016/j.jstrokecerebrovasdis.2025.108300\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs).</div></div><div><h3>Results</h3><div>A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14).</div></div><div><h3>Conclusion</h3><div>In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.</div></div>\",\"PeriodicalId\":54368,\"journal\":{\"name\":\"Journal of Stroke & Cerebrovascular Diseases\",\"volume\":\"34 6\",\"pages\":\"Article 108300\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-03-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Stroke & Cerebrovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1052305725000795\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"NEUROSCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stroke & Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1052305725000795","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

摘要

急性缺血性脑卒中（AIS）是世界范围内发病率和死亡率的主要原因。虽然阿替普酶已被广泛用于急性治疗，但最近的临床试验表明，替奈普酶（TNK）可能会改善临床结果。本研究旨在比较TNK与阿替普酶的疗效和安全性。方法采用PubMed、Embase和Cochrane Library数据库，检索自成立之日起至2024年10月间的相关文献，找出0.25 mg/kg剂量的TNK与阿替普酶进行比较的随机对照试验。从两组中提取临床结果数据，并通过使用随机效应模型和合并优势比（or）生成森林图来评估。结果共纳入11项随机对照试验，共7546例患者。与阿替普酶相比，TNK在优异功能结局（mRS 0-1）方面有统计学意义的改善（OR= 1.14, 95% CI= 1.03-1.25）。功能预后良好（mRS 0-2）（OR=1.11, 95% CI= 0.9-1.25）、早期神经系统改善（OR=1.08, 95% CI= 0.93-1.26）、全因死亡（OR=0.99, 95% CI= 0.81-1.19）、症状性颅内出血（OR=1.11, 95% CI=0.81-1.52）和功能预后不良（mRS=4-6）（OR=0.95, 95% CI=0.79-1.14）的差异无统计学意义。结论在急性缺血性脑卒中患者中，TNK在实现良好的功能预后方面优于阿替普酶。早期神经系统改善、症状性颅内出血、全因死亡和功能不良的发生率在两组之间保持相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials

Introduction

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase.

Methods

A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs).

Results

A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14).

Conclusion

In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.