IV Thrombolysis Does Not Improve Vision in Acute CRAO: Ahmed Koriesh on TenCRAOS Study
Ahmed Koriesh, Director Hospital Neurology Service at Cleveland Clinic Florida, shared on LinkedIn:
”TenCRAOS — IV Thrombolysis Does Not Improve Vision in Acute CRAO
IV thrombolysis for central retinal artery occlusion (CRAO) has always been a debated topic.
Evidence has been limited — CRAO is uncommon, patients present late, and trials have been small. For years, we’ve had more questions than answers.
TenCRAOS (2026) randomized 78 patients with acute CRAO to IV tenecteplase (0.25 mg/kg) vs aspirin within 4.5 hours.
Key Findings:
Primary outcome: 20% TNK vs 24% aspirin (P = 0.69)
No visual benefit with IV thrombolysis
Safety signal: 1 fatal ICH; more SAEs with TNK (10 vs 4)
This is now the second negative RCT for IV thrombolysis in CRAO:
THEIA (2025): IV alteplase vs aspirin — no difference (66% vs 48%, P = 0.95)
What did guidelines say?
The AHA/ASA Scientific Statement (2021) on CRAO management stated that IV alteplase “may be considered” in carefully selected patients within 4.5 hours, with weak evidence (no RCT at that time) — this recommendation may need revisiting.
What about the AGILE meta-analysis?
The AGILE IPD meta-analysis (2025, N = 783) suggested early thrombolysis improves visual outcomes — but important caveats:
Pooled 35 studies, mostly single-arm observational studies — inherent selection bias
Subgroup of comparative studies was underpowered and could not reproduce the findings
Control group was heterogeneous (ocular massage, paracentesis, hemodilution, HBO, heparin) — not aspirin
However, AGILE did show potential benefit for intra-arterial thrombolysis (IAT) within 6 hours (OR 2.72 vs CST) — this still warrants RCT investigation.
Bottom Line:
IV thrombolysis for CRAO: RCT evidence is consistently negative — not recommended.
IA thrombolysis: Still under investigation.
AGILE suggests potential benefit within 6 hours, but RCT confirmation is needed.
So far, the evidence doesn’t support routine IV thrombolysis for acute CRAO.”
Stay updated on all scientific advances with Hemostasis Today.
-
May 11, 2026, 16:52Luke McLaughlin: Raising Awareness on Haemophilia Issues at ENIL Lead On
-
May 11, 2026, 16:49Jeff Sternlicht: Normal LDL Does Not Always Mean Low Risk
-
May 11, 2026, 16:42Archil Jaliashvili: From Managing Blood to Managing Oxygen Metabolism
-
May 11, 2026, 16:42Heghine Khachatryan: Celebrating One Hundred Years of von Willebrand Disease with EHC
-
May 11, 2026, 16:34Jane Hankins: Excited to Have Been a Part of the Faculty of ASH CRTI LA
-
May 11, 2026, 16:28Conan McIlwrath at the Rare Bleeding Disorders Conference Representing The Haemophilia Society as Chair
-
May 11, 2026, 16:24Anna A. Avagyan: Presenting Armenia’s Experience at SIOP Europe 2026
-
May 11, 2026, 16:18Mohamed Elkhider: Raising Awareness on Aortic Dissection
-
May 11, 2026, 16:11David McIntosh: A Pensioner’s Reflections on Blood Donation