Efficacy and Safety of Tenecteplase in Minor Ischemic Stroke: A Systematic Review and Meta-analysis
Meiling Carbajal Galarza1, Irving Calizaya1, Nestor Flores-Rodriguez2, Sandra Berru Villalobos2, Carlos Abanto2
1Universidad Peruana Cayetano Heredia, 2Instituto Nacional de Ciencias Neurologicas
Objective:
 We performed a meta-analysis to compare the efficacy and safety of tenecteplase against alteplase or medical therapy in patients with minor ischemic stroke. 
Background:
Tenecteplase is increasingly considered as an alternative to alteplase or medical therapy for patients with acute ischemic stroke, but evidence in minor, non-disabling presentations remains limited.
Design/Methods:

A systematic search of PubMed, Web of Science, Embase, and Cochrane Library was performed to identify randomized controlled trials and prospective studies enrolling patients with minor ischemic stroke (NIHSS ≤5). Eligible studies compared intravenous tenecteplase with alteplase or medical therapy. The primary outcome was functional independence at 90 days (mRS 0–1); secondary outcomes included symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized trials and the Newcastle–Ottawa Scale for observational studies. Pooled odds ratios with 95% confidence intervals were estimated using random-effects models, and heterogeneity was quantified with the I² statistic.


Results:

A total of 1,293 studies were screened, of which five studies met the inclusion criteria (three randomized trials and two cohorts)  comprising 1,677 patients (844 tenecteplase, 833 comparators). Tenecteplase was not associated with a higher likelihood of achieving mRS 0–1 compared with alteplase (OR 1.20, 95% CI, 0.84–1.70; I² = 0%) or  with medical therapy alone (OR 0.90, 95% CI, 0.68–1.19; I² = 0%). In secondary analyses, two studies (n=946) suggested a borderline increased risk of sICH with tenecteplase vs medical therapy  (OR 4.00, 95% CI 0.98–16.26; p=0.053; I²=0%). Mortality did not significantly differ between tenecteplase and alteplase (2 trials, n=526; OR 0.67, 95% CI 0.28–1.60; I²=32%).


Conclusions:
In patients with minor ischemic stroke, tenecteplase did not improve functional independence at 90 days compared with alteplase or medical therapy. No significant difference in mortality was observed, while a possible safety signal for increased sICH warrants further investigation.
10.1212/WNL.0000000000217744
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