Acute ischemic stroke (AIS) management has long relied on timely thrombolysis to restore cerebral perfusion. While intravenous (IV) alteplase has been the standard of care since its approval in 1996, tenecteplase (TNK)—a modified tissue plasminogen activator (tPA)—has emerged as a promising alternative due to its ease of administration and pharmacokinetic advantages.1
Tenecteplase offers a streamlined approach to thrombolysis, delivered as a single IV bolus over 5-10 seconds, which differs from the hour-long infusion required for alteplase. The recommended dosing for AIS is 0.25 mg/kg (maximum 25 mg), a regimen supported by trials such as EXTEND-IA and ACT, which demonstrated comparable efficacy in achieving early reperfusion.2 Some studies have explored a higher 0.4 mg/kg dose, though concerns remain regarding increased hemorrhagic risk.2,3
Current guidelines recognize tenecteplase as an alternative to alteplase for eligible AIS patients, particularly in large vessel occlusions where rapid thrombolysis can facilitate mechanical thrombectomy.2 Ideal candidates include patients presenting within 3 hours of symptom onset, without contraindications such as recent major surgery, active bleeding, or severe hypertension.2
The advantages of tenecteplase extend beyond its efficacy—its bolus administration reduces delays in treatment, making it particularly valuable in prehospital settings and hospitals without specialized stroke units.4 As stroke care continues to evolve, integrating tenecteplase into broader thrombolysis protocols may improve access to timely, effective reperfusion therapy, ultimately optimizing outcomes for AIS patients.
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