SynthesisCNS drugs2026
Tenecteplase Beyond the 4.5-h Window for Patients with Acute Ischemic Stroke: An Updated Meta-Analysis of Randomized Controlled Trials.
Synthesis in CNS drugs, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIntravenous thrombolysis (IVT) is the established treatment for acute ischemic stroke (AIS) when administered within 4.5 h of the last known well (LKW) status. However, this narrow therapeutic window limits the number of patients eligible for treatment. In this context, tenecteplase (TNK) is being investigated as an alternative thrombolytic agent in the extended time window.
objectiveThe objective of this study was to evaluate the safety and efficacy of intravenous TNK in patients with AIS treated in the extended time window (beyond 4.5 h from LKW) compared with best medical treatment (BMT) without IVT.
methodsWe conducted a systematic literature review and meta-analysis of patients with AIS presenting beyond 4.5 h from LKW treated with TNK or BMT in randomized controlled trials (RCTs). The safety outcomes included: (1) symptomatic intracranial hemorrhage (sICH), (2) mortality at 90 days, (3) any intracranial hemorrhage (ICH), and (4) parenchymal hemorrhage type 2 (PH2). The efficacy outcomes included: (1) excellent functional outcome (modified Rankin scale [mRS] 0-1) at 90 days, (2) functional independence (mRS 0-2) at 90 days, and (3) early neurological improvement. An analysis based on odds ratios (OR) with 95% confidence intervals (CI) under a random-effects model was used for data pooling. Heterogeneity was assessed using the Q test and its P-value, with the magnitude evaluated by I
resultsA total of 6 RCTs including 2297 patients were analyzed, with 1152 patients receiving TNK and 1145 receiving BMT. Compared with BMT, TNK administered in the extended time window was associated with significantly higher rates of excellent functional outcomes (mRS 0-1: OR 1.40, 95% CI 1.18-1.67; P < 0.001), functional independence (mRS 0-2: OR 1.27, 95% CI 1.07-1.51; P = 0.006), and early neurological improvement (OR 3.21, 95% CI 1.82-5.66; P < 0.001). TNK was associated with a significant increase in sICH (OR 2.34, 95% CI 1.11-4.95; P = 0.026). No significant differences were observed in 90-day mortality (OR 1.17, 95% CI 0.89-1.55), any ICH (OR 1.61, 95% CI 0.37-6.95), or PH2 (OR 1.81, 95% CI 0.90-3.64).
conclusionsIn patients with AIS treated beyond 4.5 h from symptom onset, intravenous TNK significantly improves functional outcomes and early neurological recovery compared with BMT, without a significant increase in mortality. Although sICH was significantly increased, absolute rates remained low. These findings support the potential role of tenecteplase as an effective thrombolytic option in the extended time window for carefully selected patients. REGISTRATION: PROSPERO identifier no. CRD420251060492.
Indexed as
Identifiers
42307864What 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.