Evidence map›Paper›PMID 39266015›Full record

ReviewJournal of stroke2024

Ethnic Differences in the Safety and Efficacy of Tenecteplase Versus Alteplase for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Jin Hean Koh, Claire Yi Jia Lim, Lucas Tze Peng Tan, Ching-Hui Sia, Kian Keong Poh, Vijay Kumar Sharma, Leonard Leong Litt Yeo, Andrew Fu Wah Ho, Teddy Wu, William Kok-Fai Kong and 1 more

Abstract readReview
In one paragraph

Review in Journal of stroke, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Development of tenecteplase for stroke thrombolysis: Japan's endeavor.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Review
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jin Hean KohYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Claire Yi Jia LimFaculty of Medical and Health Sciences, University of Auckland, New Zealand.
Lucas Tze Peng TanFaculty of Medical and Health Sciences, University of Auckland, New Zealand.
Ching-Hui SiaYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Kian Keong PohYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Vijay Kumar SharmaYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Leonard Leong Litt YeoYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Andrew Fu Wah HoPrehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore.
Teddy WuDepartment of Neurology, Christchurch Hospital, Christchurch, New Zealand.
William Kok-Fai KongYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Benjamin Yong Qiang TanYong Loo Lin School of Medicine, National University of Singapore, Singapore.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeTenecteplase is a thrombolytic agent with pharmacological advantages over alteplase and has been shown to be noninferior to alteplase for acute ischemic stroke in randomized trials. However, evidence pertaining to the safety and efficacy of tenecteplase in patients from different ethnic groups is lacking. The aim of this systematic review and metaanalysis was to investigate ethnicity-specific differences in the safety and efficacy of tenecteplase versus alteplase in patients with acute ischemic stroke.

methodsFollowing an International Prospective Register of Systematic Reviews (PROSPERO)- registered protocol (CRD42023475038), three authors conducted a systematic review of the PubMed/MEDLINE, Embase, Cochrane Library, and CINAHL databases for articles comparing the use of tenecteplase with any thrombolytic agent in patients with acute ischemic stroke up to November 20, 2023. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two independent authors extracted data onto a standardized data collection sheet. A pairwise meta-analysis was conducted in risk ratios (RR).

resultsFrom 34 studies (59,601 participants), the rate of complete recanalization was significantly higher (P<0.01) in Asian (RR: 1.91, 95% confidence interval [CI]: 1.30 to 2.80) versus Caucasian patients (RR: 0.99, 95% CI: 0.87 to 1.14). However, Asian patients (RR: 1.18, 95% CI: 0.87 to 1.62) had significantly higher (P=0.01) rates of mortality compared with Caucasian patients (RR: 1.10, 95% CI: 1.00 to 1.22). Caucasian patients were also more likely to attain a modified Rankin Scale (mRS) score of 0 to 2 at follow-up (RR: 1.14, 95% CI, 1.10 to 1.19) compared with Asian (RR: 1.00, 95% CI, 0.95 to 1.05) patients. There was no significant difference in the rate of symptomatic intracranial hemorrhage (P=0.20) and any intracranial hemorrhage (P=0.83) between Asian and Caucasian patients.

conclusionTenecteplase was associated with significantly higher rates of complete recanalization in Asian patients compared with Caucasian patients. However, tenecteplase was associated with higher rates of mortality and lower rates of mRS 0 to 2 in Asian patients compared with Caucasian patients. It may be beneficial to study the variations in response to tenecteplase among patients of different ethnic groups in large prospective cohort studies.

Indexed as

Acute strokeBrainIschemic strokeThrombolysis

Identifiers

PMID39266015
PMCPMC11471352

What OpenQuestion holds

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Registered trials

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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.