Evidence map›Paper›PMID 40494577›Full record

ReviewJournal of stroke2025

Tenecteplase Beyond 4.5 Hours in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Mohammad Aladawi, Mohammad T Abuawwad, Mohammad J J Taha, Yasmeena Abdelall Kozaa, Warda A Alrubasy, Abdullah Hamad, Fatema Ahmad Alhnidi, Mohamed Elfil, Zaid Najdawi, Xiaohan Peng and 3 more

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PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 4 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

6 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Review
  6. 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

13 authors.

Mohammad AladawiDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Mohammad T AbuawwadKasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Mohammad J J TahaKasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Yasmeena Abdelall KozaaMansoura Manchester Medical Program for Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Warda A AlrubasyKasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Abdullah HamadKasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Fatema Ahmad AlhnidiKasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Mohamed ElfilDepartment of Neurology, University of Miami/Jackson Health System, Miami, FL, USA.
Zaid NajdawiDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Xiaohan PengDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Felicia HatawayDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Ekaterina BakradzeDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Michael J LyerlyDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeAcute ischemic stroke (AIS) is a leading cause of disability worldwide. While intravenous thrombolysis is recommended within 4.5 hours of last known well (LKW) time, many patients present beyond this window.

methodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating tenecteplase (TNK) administration in AIS patients within 4.5 to 24 hours of LKW. The primary outcomes assessed functional independence and ordinal modified Rankin Scale (mRS) shift at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days.

resultsThree RCTs were included, comprising 1,054 patients (532 TNK and 522 standard medical therapy) with a mean age of 69 years, 59% males, and median baseline National Institutes of Health Stroke Scale score of 10.5. TNK treatment was associated with mRS 0-2 at 90 days (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.04-1.70, P=0.023), indicating a 33% higher likelihood of achieving functional independence. However, the ordinal mRS shift showed no significant difference (standardized mean difference: 0.01, 95% CI: -0.37-0.39, P=0.09). Safety outcomes indicated no difference in the rates of sICH (OR: 2.07, 95% CI: 0.86-5.00, P=0.1), and no difference in 90-day mortality (OR: 1.08, 95% CI: 0.76-1.53, P=0.67).

conclusionThis meta-analysis suggests TNK might be safe and effective for selected AIS patients in the 4.5- to 24-hour time window, offering improved functional outcomes without a significant increase in hemorrhagic complications.

Indexed as

Acute ischemic strokeExtended treatment windowIntravenous thrombolysisTenecteplase

Identifiers

PMID40494577
PMCPMC12152445

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.