ReviewTherapeutic advances in neurological disorders2021
Off-label use of intravenous thrombolysis for acute ischemic stroke: a critical appraisal of randomized and real-world evidence.
Review in Therapeutic advances in neurological disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis.Journal of neurology · 2022Pooled it
- Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis.JAMA network open · 2022Pooled it
- Efficacy and Safety of Recombinant Human Prourokinase in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- When thrombus meets intracranial dissection: a tricky decision for intravenous thrombolysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- When an incidental finding should not stop acute stroke treatment.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Low Fibrinogen Levels Are Associated with an Increased Risk of Parenchymal Hematoma in Ischemic Stroke Treated with Intravenous Thrombolysis.Journal of clinical medicine · 2026Article
- Prognostic analysis of cerebral microbleeds in patients with large artery atherosclerotic stroke without thrombolytic therapy.European journal of medical research · 2025Article
- Optimal Timing of Oral Anticoagulant Therapy Initiation Post-acute Ischemic Stroke: A Narrative Review.Cureus · 2025Review
- Effectiveness and Limitations of Intravenous rt-PA Therapy in Patients with Mild Cerebral Infarction.Journal of atherosclerosis and thrombosis · 2025Review
- Tenecteplase for ischemic stroke at 4.5 to 24 hours without thrombectomy: a cost-utility analysis from the perspective of Chinese healthcare system.Frontiers in neurology · 2025Article
- Automated Identification of Stroke Thrombolysis Contraindications from Synthetic Clinical Notes: A Proof-of-Concept Study.Cerebrovascular diseases extra · 2025Article
- Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.Annals of neurosciences · 2024Review
- Article
- Tenecteplase for the treatment of acute ischemic stroke in the extended time window: a systematic review and meta-analysis.Therapeutic advances in neurological disorders · 2024Article
- Opinion: can we bust the fear of symptomatic intracerebral hemorrhage due to tPA?Frontiers in neurology · 2024Article
- Development and Validation of a UHPLC-MS/MS Method for the Quantification of a Novel PYGB Inhibitor in Plasma: Application to Pharmacokinetic Studies.Molecules (Basel, Switzerland) · 2023Article
- European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke.European stroke journal · 2023Article
- Acute Ischemic Stroke in Pregnancy : A Practical Focus on Neuroimaging and Reperfusion Therapy.Clinical neuroradiology · 2023Review
- Exploring the Impact of Cerebral Microbleeds on Stroke Management.Neurology international · 2023Review
- Prospective collection of blood plasma samples to identify potential biomarkers for the prehospital stroke diagnosis (ProGrEss-Bio): study protocol for a multicenter prospective observational study.Frontiers in neurology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 11 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Intravenous thrombolysis (IVT) represents the only systemic reperfusion therapy able to reverse neurological deficit in patients with acute ischemic stroke (AIS). Despite its effectiveness in patients with or without large vessel occlusion, it can be offered only to a minority of them, because of the short therapeutic window and additional contraindications derived from stringent but arbitrary inclusion and exclusion criteria used in landmark randomized controlled clinical trials. Many absolute or relative contraindications lead to disparities between the official drug label and guidelines or expert recommendations. Based on recent advances in neuroimaging and evidence from cohort studies, off-label use of IVT is increasingly incorporated into the daily practice of many stroke centers. They relate to extension of therapeutic time windows, and expansion of indications in co-existing conditions originally listed in exclusion criteria, such as use of alternative thrombolytic agents, pre-treatment with antiplatelets, anticoagulants or low molecular weight heparins. In this narrative review, we summarize recent randomized and real-world data on the safety and efficacy of off-label use of IVT for AIS. We also make some practical recommendations to stroke physicians regarding the off-label use of thrombolytic agents in complex and uncommon presentations of AIS or other conditions mimicking acute cerebral ischemia. Finally, we provide guidance on the risks and benefits of IVT in numerous AIS subgroups, where equipoise exists and guidelines and treatment practices vary.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.