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.”

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