特奈特普酶
医学
溶栓
脑出血
荟萃分析
随机对照试验
冲程(发动机)
纤溶剂
科克伦图书馆
置信区间
相对风险
内科学
组织纤溶酶原激活剂
重症监护医学
蛛网膜下腔出血
心肌梗塞
工程类
机械工程
作者
Aqeeb Ur Rehman,Aleenah Mohsin,Huzaifa Ahmad Cheema,Afra Zahid,Muhammad Ebaad Ur Rehman,Muhammad Zain Ameer,Muhammad Ayyan,Muhammad Ehsan,Abia Shahid,Muhammad Aemaz Ur Rehman,Jaffer Shah,Ayaz Khawaja
标识
DOI:10.1016/j.jns.2022.120537
摘要
Studies on tenecteplase have been yielding mixed results for several important outcomes at different doses, thus hampering objective guideline recommendations in acute ischemic stroke management. This meta-analysis stratifies doses in order to refine our interpretation of outcomes and quantify the benefits and harms of tenecteplase at different doses.PubMed/MEDLINE, the Cochrane Library, and reference lists of the included articles were systematically searched. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Network meta-analysis was used to find the optimal dose of tenecteplase. Meta-regression was run to investigate the impact of baseline NIHSS scores on functional outcomes and mortality.Ten randomized controlled trials with a total of 4140 patients were included. 2166 (52.32%) patients were enrolled in the tenecteplase group and 1974 (47.68%) in the alteplase group. Tenecteplase at 0.25 mg/kg dose demonstrated significant improvement in excellent functional outcome at 3 months (RR 1.14, 95% CI 1.04-1.26), and early neurological improvement (RR 1.53, 95% CI 1.03-2.26). There was no statistically significant difference between tenecteplase and alteplase in terms of good functional outcome, intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality at any dose. Meta-regression demonstrated superior tenecteplase efficacy with increasing stroke severity, however, the results were statistically nonsignificant.Tenecteplase at 0.25 mg/kg dose is more efficacious and at least as safe as alteplase for stroke thrombolysis. Newer analyses need to focus on direct comparison of tenecteplase doses and whether tenecteplase is efficacious at longer needle times.
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