Tenecteplase

WEDNESDAY, Feb. 4, 2026 -- In a guideline issued by the American Heart Association/American Stroke Association and published online Jan. 26 in Stroke , updated recommendations are presented for the early management of patients with acute ischemic stroke (AIS). Shyam Prabhakaran, M.D., from the University of Chicago, and colleagues updated the guideline for the early management of patients with AIS to replace the 2018 guideline. The authors note that mobile stroke units (MSU) enable rapid identification and treatment of thrombolytic-eligible patients with AIS and included recommendations relating to MSU implementation. For patients with suspected stroke in the prehospital setting, the guideline endorses consideration of the characteristics of the local system of care and direct transport to the closest endovascular thrombectomy (EVT)-capable hospital. For patients with AIS, intravenous thrombolysis is a mainstay of medical management; the new guideline endorses the use of either alteplase or tenecteplase in the 4.5-hour thrombolytic treatment window. Rapid thrombolytic treatment within the 4.5-hour window is recommended for eligible patients with disabling deficits, regardless of the National Institutes of Health Stroke Scale (NIHSS) score, without advanced imaging selection. The benefit of thrombolysis has not been demonstrated for patients with nondisabling deficits in the 4.5-hour window. EVT has been established as standard treatment for patients with AIS with large vessel occlusion and should be considered in patients previously considered ineligible. For patients with basilar artery occlusion presenting within 24 hours of symptom onset and with an NIHSS score ≥10, EVT is strongly recommended. Recommendations are also included for interventional treatment in pediatric patients with AIS. "New recommendations in the guideline expand access to cutting-edge treatments, such as clot-removal procedures and medications, simplify imaging requirements so more hospitals can act quickly, and introduce guidance for pediatric stroke for the first time," Prabhakaran said in a statement. Several members of the Writing Committee and Peer Review Committee disclosed ties to the biopharmaceutical industry. Abstract/Full Text

MONDAY, Feb. 2, 2026 -- Intravenous tenecteplase administered within 4.5 hours after onset of central retinal artery occlusion does not improve vision recovery at 30 days compared with oral aspirin , according to a study published in the Jan. 29 issue of the New England Journal of Medicine . Stephen J. Ryan, M.D., from Oslo University Hospital in Norway, and colleagues conducted a phase 3, randomized, controlled trial involving adults with acute, nonarteritic central retinal artery occlusion who had symptom onset within 4.5 hours before treatment. Patients at 16 sites in six countries were randomly assigned to receive intravenous tenecteplase and oral placebo or intravenous placebo and oral aspirin (40 and 38 individuals, respectively). Vision recovery was assessed as the primary end point, defined as a best corrected visual acuity (BCVA) in the affected eye of up to 0.7 logMAR at 30 days. The researchers found that 20 and 24 percent of patients in the tenecteplase and aspirin groups, respectively, had vision recovery at 30 days (risk difference, −3.7 percentage points; 95 percent confidence interval, −22.0 to 14.7; P = 0.69). With regard to secondary visual end points of a BCVA of up to 0.5 logMAR, mean improvement in BCVA, and perimetry score at 30 days, no substantial difference was seen between the groups. A greater incidence of adverse events was seen in the tenecteplase group, including one fatal intracranial hemorrhage. "These findings do not support the routine use of thrombolytic therapy to treat central retinal artery occlusion," the authors write. The study was supported by an unconditional grant from Boehringer Ingelheim Norway for the purchase of tenecteplase. Abstract/Full Text (subscription or payment may be required)