TNK May Be Effective, Safe Up to 24 Hours From Stroke Symptom Onset

Background: The definition of stroke changed from a time-based concept to a tissue damage concept over 20 years ago. Nevertheless, we still use a specific time window to administer tissue plasminogen activator, be that alteplase or tenecteplase (TNK). Whether TNK is efficacious after a 4.5-hour window is still not clear. Objective: To determine the safety and efficacy of TNK in patients with acute ischemic stroke (AIS) treated within 4.5 to 24 hours after AIS onset. Design/Methods: A meta-analysis of randomized controlled trials (RCTs) comparing IV TNK at 0.25 mg/kg with standard of care (endovascular thrombectomy where and when available) or placebo in adult patients with an AIS within 4.5 to 24.0 hours after stroke symptom onset. The primary outcome was a modified Rankin Scale (mRS) score of 0 or 1 (excellent functional outcome) at 90 days, with additional safety points. Results: 4 multicenter RCTs that fulfilled the inclusion criteria, involving 1278 patients, were included. These more...