Mohamed Sherif Salem: Expanding the Role of Tenecteplase in Acute Ischemic Stroke
Mohamed Sherif Salem, Senior Clinical Pharmacist at Andalusia Health Egypt, shared post on LinkedIn, about a recent article by Yunyun Xiong et al, published in The Lancet, adding:
“Intravenous thrombolysis (IVT) remains a cornerstone in the management of acute ischemic stroke, with a well-established treatment window of up to 4.5 hours from symptom onset.
However, emerging evidence is challenging this boundary and expanding the role of thrombolysis in carefully selected patients.
Recent trials are exploring the use of tenecteplase (TNK) beyond the conventional window, extending up to 24 hours in specific clinical scenarios guided by advanced imaging.
The TRACE-5 trial provides important insight in this area.
In patients with basilar artery occlusion treated within 24 hours, IVT with tenecteplase was associated with a higher likelihood of achieving an excellent functional outcome.
Notably, mechanical thrombectomy was allowed based on clinician judgment, reflecting real-world practice.
Similarly, the OPTION trial evaluated patients without large vessel occlusion but with imaging evidence of salvageable brain tissue.
In this group, tenecteplase improved functional outcomes even in the extended time window.
This benefit came with a small but measurable increase in symptomatic intracranial hemorrhage, highlighting the need for careful patient selection.
Taken together, these findings suggest a potential shift toward tissue-based rather than strictly time-based decision-making in acute stroke care.
While further validation is needed, tenecteplase may play an expanding role in extending treatment opportunities for patients who would previously have been considered ineligible.”
Title: Tenecteplase versus standard medical treatment for basilar artery occlusion within 24 h (TRACE-5): a multicentre, prospective, randomised, open-label, blinded-endpoint, superiority, phase 3 trial
Authors: Yunyun Xiong, Fana Alemseged, Zhixin Cao, Lee H Schwamm, Si Zhang, Mark W Parsons, Marc Fisher, Yahui Hao, Aoming Jin, Jinfeng Yin, Yong Jiang, Fengyuan Che, Lihua Wang, Li Zhou, Hongguo Dai, Yutie Zhao, Chunmiao Duan, Shuangzhe Wu, Ganghua Feng, Lixia Zong, Wanxing Ye, Ziran Wang, Ziqi Xu, Hao Wang, Manjun Hao, Yujie Ma, Xia Meng, Hao Li, Zixiao Li, Yilong Wang, Liping Liu, Xingquan Zhao, Bruce C V Campbell, Yongjun Wang
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