Efficacy and safety analysis of tenecteplase vs. alteplase in very elderly patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials.

Keying Zhang, Qi Wang, Tao Gong, Yuhui Chen

Abstract read

In one paragraph

Article in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in

0citing papers in PubMed

–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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

4 authors.

Keying ZhangNeurology Department, Beijing Hospital，National Center for Gerontology；National Clinical Research Center for Gerontology；The Key Laboratory of Geriatrics of NHC；Institute of Geriatric Medicine，Chinese Academy of Medical Sciences, Beijing, China.

Qi WangSchool of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Tao GongNeurology Department, Beijing Hospital，National Center for Gerontology；National Clinical Research Center for Gerontology；The Key Laboratory of Geriatrics of NHC；Institute of Geriatric Medicine，Chinese Academy of Medical Sciences, Beijing, China.

Yuhui ChenNeurology Department, Beijing Hospital，National Center for Gerontology；National Clinical Research Center for Gerontology；The Key Laboratory of Geriatrics of NHC；Institute of Geriatric Medicine，Chinese Academy of Medical Sciences, Beijing, China. cmucyh@163.com.ORCID http://orcid.org/0000-0002-7052-6783

Funding

the National High Level Hospital Clinical Research Funding BJ-2019-200the National High Level Hospital Clinical Research Funding BJ-2022-119

6 · The paper itself

Abstract

Tenecteplase (TNK) is a modified variant of alteplase (TPA) that offers advantages such as a long plasma half-life and high fibrin specificity. Previous studies have demonstrated the noninferiority of TNK to TPA in patients with acute ischemic stroke (AIS). Although very elderly patients (aged ≥ 80 years) represent a significant proportion of AIS cases, research on the safety and efficacy of TNK in this population remains limited. Therefore, this study aimed to evaluate the comparative efficacy and safety of TNK versus TPA in treating AIS in very elderly patients. We conducted a meta-analysis of randomized controlled trials (RCTs) from Embase, PubMed, and the Cochrane Library up to May 20th, 2026. The outcomes included modified Rankin Scale (mRS) scores of 0-1 and 0-2 at 90 days, symptomatic intracranial hemorrhage (SICH), all-cause mortality, and parenchymal hematoma. We also performed subgroup analysis to assess the effects of patient race. We utilized mainly Review Manager 5.4 software to conduct the data synthesis and statistical analysis. Five RCTs (EXTEND-IA TNK, AcT, ATTEST-2, TRACE-2, and ORIGINAL) involving 1307 very elderly patients were included. Pooled analysis showed that TNK was associated with higher odds of excellent and good functional outcomes at 90 days compared with TPA (excellent: odds ratio (OR) 1.85, 95% confidence interval (CI) 1.06-3.23, p = 0.03, I

Indexed as

Acute ischemic strokeAlteplaseTenecteplaseVery elderly

Identifiers

PMID42704605

DOI10.1161/Strokeaha.120.029666

What OpenQuestion holds

Textmetadata

Read underepoch 390

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.