Evidence map›Paper›PMID 41078125›Full record

SynthesisStroke2026

Tenecteplase for Acute Ischemic Stroke at 4.5 to 24 Hours: A Meta-Analysis of Randomized Controlled Trials.

Zixin Wang, Jiamin Li, Xinyi Wang, Boyi Yuan, Jiameng Li, Qingfeng Ma

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Stroke, 2026. 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. Review
  3. Article
  4. Article
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

6 authors.

Zixin WangDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Z.W., Jiamin Li, X.W., B.Y., Jiameng Li, Q.M.).
Jiamin LiDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Z.W., Jiamin Li, X.W., B.Y., Jiameng Li, Q.M.).
Xinyi WangDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Z.W., Jiamin Li, X.W., B.Y., Jiameng Li, Q.M.).
Boyi YuanDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Z.W., Jiamin Li, X.W., B.Y., Jiameng Li, Q.M.).
Jiameng LiDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Z.W., Jiamin Li, X.W., B.Y., Jiameng Li, Q.M.).
Qingfeng MaDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (Z.W., Jiamin Li, X.W., B.Y., Jiameng Li, Q.M.).ORCID 0000-0002-0114-6402

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhether TNK (tenecteplase) benefits patients with acute ischemic stroke treated within 4.5 to 24 hours remains uncertain, and no previous meta-analysis has differentiated between clinical settings where endovascular thrombectomy (EVT) is unavailable or permitted, leading to pooled distinct clinical contexts and obscuring a clear estimation of TNK's net effect.

methodsWe searched for randomized controlled trials comparing intravenous TNK of 0.25 mg/kg with standard care or placebo in adults within 4.5 to 24 hours after acute ischemic stroke onset. The primary outcome was excellent functional outcome (modified Rankin Scale score, 0-1) at 90 days, with additional efficacy and safety end points. A random-effects meta-analysis was performed both overall and within predefined subgroups, stratified by whether EVT was permitted in individual studies (non-EVT versus EVT-permitted).

resultsFour multicenter randomized controlled trials enrolling 1278 patients were included. TNK significantly increased excellent functional outcome (odds ratio [OR], 1.34 [95% CI, 1.06-1.71];

conclusionsTNK improves excellent functional outcomes and recanalization in patients with acute ischemic stroke treated within 4.5 to 24 hours, without increasing the risks of symptomatic intracerebral hemorrhage or mortality. Notably, extended-window TNK provides greater additional benefits when EVT is inaccessible, establishing its role as an alternative reperfusion strategy in resource-limited settings.

Indexed as

Brain IschemiaFibrinolytic AgentsIschemic StrokeStrokeTenecteplaseTissue Plasminogen ActivatorHumansRandomized Controlled Trials as TopicThrombectomyTime FactorsTreatment OutcomeFibrinolytic AgentsTenecteplaseTissue Plasminogen Activatorfibrinolytic agentsischemic strokestroketenecteplasethrombolytic therapy

Identifiers

PMID41078125
PMCPMC12721659

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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.