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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(05): s00451808088
DOI: 10.1055/s-0045-1808088
Review Article

Tenecteplase in acute ischemic stroke: a new era in thrombolysis

Gisele Sampaio Silva 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
2   Hospital Israelita Albert Einstein, Centro de Ensino e Pesquisa, São Paulo SP, Brazil.
,
Eva Rocha 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Octávio Marques Pontes-Neto 
3   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
,
Sheila Ouriques Martins 
4   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil.
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Abstract

Tenecteplase (TNK) is a genetically engineered variant of alteplase, showing promise for acute ischemic stroke treatment. With a longer half-life and higher fibrin specificity, TNK enables more targeted and efficient clot dissolution. Clinical trials demonstrate potential advantages, including improved reperfusion rates and functional outcomes with lower systemic bleeding. Though not officially approved for this purpose by all regulatory agencies, TNK is used off-label and in acute stroke guidelines due to its ease of administration and effectiveness. The 0.25 mg/kg dosage within 4.5 hours of symptom onset was shown to be consistently effective and safe. Further trials are expected to identify patient subgroups that benefit most from TNK treatment. The present narrative review assesses the existing literature and evidence regarding the use of tenecteplase for the treatment of acute ischemic stroke.

Keywords

Ischemic Stroke - Thrombolytic Therapy - Tenecteplase

Authors' Contributions

Conceptualization: GSS, ER; Data curation: GSS, ER; Formal analysis: GSS; Project administration: GSS, ER; Supervision: GSS; Writing – original draft: GSS, ER; Writing – review & editing: GSS, ER, OMPN, SCOM. GSS and ER contributed equally to the manuscript.


Editor-in-Chief: Ayrton Roberto Massaro.


Associate Editor: Jamary Oliveira Filho.




Publication History

Received: 19 August 2024

Accepted: 13 February 2025

Article published online:
01 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Gisele Sampaio Silva, Eva Rocha, Octávio Marques Pontes-Neto, Sheila Ouriques Martins. Tenecteplase in acute ischemic stroke: a new era in thrombolysis. Arq Neuropsiquiatr 2025; 83: s00451808088.
DOI: 10.1055/s-0045-1808088
 

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