Tenecteplase use in patients with acute ischaemic stroke

Physicians have always faced uncertainty when making clinical decisions. 1 Wellbery C The value of medical uncertainty?. Lancet. 2010; 375: 1686-1687 Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar Clinical research seeks to reduce such uncertainty by generating more evidence. The more evidence that supports a treatment, the less uncertainty there is around its use. 2 Djulbegovic B Guyatt GH Progress in evidence-based medicine: a quarter century on. Lancet. 2017; 390: 415-423 Summary Full Text Full Text PDF PubMed Scopus (560) Google Scholar The highest quality of evidence comes from large randomised clinical trials that include patients from diverse backgrounds and different health systems and countries. Such a body of evidence assures the front-line physician that the treatment decision taken is in the best interest of the patient. Clinical research into tenecteplase as an alternative to alteplase for intravenous thrombolysis in patients with acute ischaemic stroke has followed a similar template, with multiple phase 2 studies and, since 2022, large phase 3 studies strengthening evidence supporting its use. 3 Haley Jr, EC Thompson JL Grotta JC et al. Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke. 2010; 41: 707-711 Crossref PubMed Scopus (199) Google Scholar , 4 Parsons M Spratt N Bivard A et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2012; 366: 1099-1107 Crossref PubMed Scopus (475) Google Scholar , 5 Huang X Cheripelli BK Lloyd SM et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. Lancet Neurol. 2015; 14: 368-376 Summary Full Text Full Text PDF PubMed Scopus (202) Google Scholar , 6 Campbell BCV Mitchell PJ Churilov L et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med. 2018; 378: 1573-1582 Crossref PubMed Scopus (455) Google Scholar , 7 Menon BK Buck BH Singh N et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet. 2022; 400: 161-169 Summary Full Text Full Text PDF PubMed Scopus (99) Google Scholar Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trialTenecteplase was non-inferior to alteplase in people with ischaemic stroke who were eligible for standard intravenous thrombolytic but ineligible for or refused endovascular thrombectomy. Full-Text PDF