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Ahmed Koriesh on The Novel Approach in Use of Tenecteplase
Ahmed Koriesh/LinkedIn
Oct 27, 2025, 05:47

Ahmed Koriesh on The Novel Approach in Use of Tenecteplase

Ahmed Koriesh, Director Hospital Neurology Service at Cleveland Clinic Florida, shared on LinkedIn:

”Beyond 24 Hours: Tenecteplase Pushes the Clock Further

Last month, we asked: “Are we there yet?”

Now — with the 2025 TNK 4.5–24h Meta-Analysis, the answer may be even closer.

1,278 patients from 4 RCTs (TNK 0.25 mg/kg vs standard care/placebo)
Imaging-based selection (DWI–FLAIR mismatch or CT/MR perfusion)

Results:

  • Excellent outcome (mRS 0–1 at 90 days): 35.1% vs 28.9% (OR 1.34, p = 0.02)
  • Recanalization: 46.6% vs 28.4% (OR 3.30, p = 0.001)
  • No increase in sICH or mortality
  • Greater benefit in patients without EVT access

Interpretation:
IV tenecteplase up to 24 hours after onset appears to be beneficial and safe when guided by advanced imaging.

Clinical Pearl:

  • From 3 → 4.5 → 9 → 24 hours — thrombolysis is no longer just about time, but about tissue.
  • The line continues to blur — and that’s a good thing for stroke patients.”

Ahmed Koriesh on The Novel Approach in Use of Tenecteplase

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Ahmed Koriesh Cleveland Clinic Florida DWI–FLAIR mismatch Health Hematology Hemostasis Hemostasis Today Medicine stroke Tenecteplase thrombosis TNK
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