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Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke A Systematic Review and Meta-analysis

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  • Additional Information
    • Contributors:
      McMaster University Hamilton, Ontario; Metropolitan Hospital Piraeus, Greece (MH); Groupe hospitalier universitaire Paris psychiatrie & neurosciences Paris (GHU Paris Psychiatrie et Neurosciences); Centre Hospitalier Sainte Anne Paris; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité); FHU NeuroVasc Site Sainte-Anne, Paris (GHU-PPN); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité); Università degli Studi dell'Aquila = University of L'Aquila = Université de L'Aquila (UNIVAQ); Lusófona University Lisbon; Université de Bâle = University of Basel = Basel Universität (Unibas); National and Kapodistrian University of Athens (NKUA); Karolinska University Hospital Stockholm; Karolinska Institutet Stockholm; The University of Texas Health Science Center at Houston (UTHealth); University of Calgary; The University of Tennessee Health Science Center Memphis (UTHSC)
    • Publication Information:
      CCSD
      American Medical Association
    • Publication Date:
      2022
    • Abstract:
      International audience ; Importance: Tenecteplase is being evaluated as an alternative thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized clinical trials (RCTs). In addition, nonrandomized clinical experiences with off-label use of tenecteplase vs alteplase for AIS treatment are being published.Objective: To evaluate the available evidence on the safety and efficacy of intravenous tenecteplase compared with intravenous alteplase provided by nonrandomized studies.Data sources: Eligible studies were identified by searching MEDLINE and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 12, 2021. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal.Study selection: Nonrandomized studies (prospective or retrospective) comparing intravenous tenecteplase (at any dose) with intravenous alteplase in patients with AIS were included in the analysis.Data extraction and synthesis: The crude odds ratios (ORs) and 95% CIs were calculated for the association of tenecteplase vs alteplase with the outcomes of interest and adjusted ORs were extracted if provided. Estimates using random-effects models were pooled.Main outcomes and measures: The primary outcome was the probability of good functional outcome (modified Rankin scale [mRS] score, 0-2) at 90 days.Results: Six studies were identified including a total of 1820 patients (618 [34%] treated with tenecteplase). Patients receiving tenecteplase had higher odds of 3-month good functional outcome (crude odds ratio [OR], 1.22; 95% CI, 0.90-1.66; adjusted OR, 1.60, 95% CI, 1.08-2.37), successful recanalization (crude OR, 2.82; 95% CI, 1.12-7.10; adjusted OR, 2.38; 95% CI, 1.18-4.81), and early neurological improvement (crude OR, 4.88; 95% CI, 2.03-11.71; adjusted OR, 7.60; 95% CI, 1.97-29.41). No significant ...
    • Relation:
      info:eu-repo/semantics/altIdentifier/pmid/35357458; PUBMED: 35357458
    • Accession Number:
      10.1001/jamanetworkopen.2022.4506
    • Online Access:
      https://inserm.hal.science/inserm-03629093
      https://inserm.hal.science/inserm-03629093v1/document
      https://inserm.hal.science/inserm-03629093v1/file/katsanos_2022_oi_220157_1647963134.13403.pdf
      https://doi.org/10.1001/jamanetworkopen.2022.4506
    • Rights:
      info:eu-repo/semantics/OpenAccess
    • Accession Number:
      edsbas.646E40DD