Abstract：
BACKGROUND: Intravenous alteplase is the only thrombolytic treatment approved for patients with acute ischemic stroke (AIS). Although no randomized controlled trial (RCT) has shown the superiority of tenecteplase over alteplase in AIS, tenecteplase is increasingly used off-label in Stroke Units. The purpose of the present work was to provide an up-to-date set of expert consensus statements on the use of tenecteplase in AIS.
METHODS: Members of the working group were selected by the French Neurovascular Society. RCTs comparing tenecteplase and alteplase in the treatment of AIS were reviewed. Recent meta-analysis and real-life experience data on tenecteplase published until 30th October 2021 were also analyzed. After a description of the available data, we tried to answer the subsequent questions about the use of tenecteplase in AIS: What dosage of tenecteplase should be preferred? How effective is tenecteplase for cerebral artery recanalization? What is the clinical effectiveness of tenecteplase? What is the therapeutic safety of tenecteplase? What are the benefits associated with tenecteplase ease of use? Then expert consensus statements for tenecteplase use were submitted. In October 2021 the working group was asked to review and revise the manuscript. In November 2021, the current version of the manuscript was approved.
UNASSIGNED: A set of three expert consensus statements for the use of tenecteplase within 4.5hours of symptom onset in AIS patients were issued: (1) It is reasonable to use tenecteplase 0.25mg/kg when mechanical thrombectomy (MT) is planned. (2) Tenecteplase 0.25mg/kg can be used as an alternative to alteplase 0.9mg/kg in patients with medium- or small-vessel occlusion not retrievable with MT. (3) Tenecteplase 0.25mg/kg could be considered as an alternative to alteplase 0.9mg/kg in patients without vessel occlusion.
CONCLUSIONS: These expert consensus statements could provide a framework to guide the clinical decision-making process for the use of tenecteplase according to admission characteristics of AIS patients. However, existing data are limited, requiring inclusions in ongoing RCTs or real-life registries.
METHODS: Members of the working group were selected by the French Neurovascular Society. RCTs comparing tenecteplase and alteplase in the treatment of AIS were reviewed. Recent meta-analysis and real-life experience data on tenecteplase published until 30th October 2021 were also analyzed. After a description of the available data, we tried to answer the subsequent questions about the use of tenecteplase in AIS: What dosage of tenecteplase should be preferred? How effective is tenecteplase for cerebral artery recanalization? What is the clinical effectiveness of tenecteplase? What is the therapeutic safety of tenecteplase? What are the benefits associated with tenecteplase ease of use? Then expert consensus statements for tenecteplase use were submitted. In October 2021 the working group was asked to review and revise the manuscript. In November 2021, the current version of the manuscript was approved.
UNASSIGNED: A set of three expert consensus statements for the use of tenecteplase within 4.5hours of symptom onset in AIS patients were issued: (1) It is reasonable to use tenecteplase 0.25mg/kg when mechanical thrombectomy (MT) is planned. (2) Tenecteplase 0.25mg/kg can be used as an alternative to alteplase 0.9mg/kg in patients with medium- or small-vessel occlusion not retrievable with MT. (3) Tenecteplase 0.25mg/kg could be considered as an alternative to alteplase 0.9mg/kg in patients without vessel occlusion.
CONCLUSIONS: These expert consensus statements could provide a framework to guide the clinical decision-making process for the use of tenecteplase according to admission characteristics of AIS patients. However, existing data are limited, requiring inclusions in ongoing RCTs or real-life registries.
摘要：
背景：静脉注射阿替普酶是唯一被批准用于急性缺血性卒中（AIS）患者的溶栓治疗方法。尽管没有随机对照试验（RCT）显示替奈普酶在AIS中优于阿替普酶，替奈普酶在卒中单元中越来越多地使用标签外。本工作的目的是就Tenecteplase在AIS中的使用提供一套最新的专家共识声明。
方法：工作组成员由法国神经血管协会选出。比较替奈普酶和阿替普酶治疗AIS的RCTs。还分析了截至2021年10月30日发表的关于替奈普酶的最新荟萃分析和现实生活经验数据。在对可用数据进行描述之后，我们试图回答关于替奈普酶在AIS中使用的后续问题：替奈普酶的剂量应该是什么？替奈普酶用于脑动脉再通的效果如何？替奈普酶的临床有效性是什么？替奈普酶的治疗安全性是什么？替奈普酶易于使用相关的益处是什么？然后提交了替奈普酶使用的专家共识声明。2021年10月，工作组被要求审查和修改手稿。2021年11月，手稿的当前版本获得批准。
UNASSIGNED：发表了一组关于在AIS患者症状发作后4.5小时内使用替奈普酶的专家共识声明：（1）在计划使用机械血栓切除术（MT）时使用替奈普酶0.25mg/kg是合理的。（2）对于MT无法恢复的中小血管闭塞患者，替奈普酶0.25mg/kg可替代阿替普酶0.9mg/kg。（3）替奈普酶0.25mg/kg可作为阿替普酶0.9mg/kg无血管闭塞患者的替代药物。
结论：这些专家共识声明可以提供一个框架，以指导根据AIS患者的入院特征使用替奈普酶的临床决策过程。然而,现有数据有限，需要纳入正在进行的RCT或现实生活中的登记册。
方法：工作组成员由法国神经血管协会选出。比较替奈普酶和阿替普酶治疗AIS的RCTs。还分析了截至2021年10月30日发表的关于替奈普酶的最新荟萃分析和现实生活经验数据。在对可用数据进行描述之后，我们试图回答关于替奈普酶在AIS中使用的后续问题：替奈普酶的剂量应该是什么？替奈普酶用于脑动脉再通的效果如何？替奈普酶的临床有效性是什么？替奈普酶的治疗安全性是什么？替奈普酶易于使用相关的益处是什么？然后提交了替奈普酶使用的专家共识声明。2021年10月，工作组被要求审查和修改手稿。2021年11月，手稿的当前版本获得批准。
UNASSIGNED：发表了一组关于在AIS患者症状发作后4.5小时内使用替奈普酶的专家共识声明：（1）在计划使用机械血栓切除术（MT）时使用替奈普酶0.25mg/kg是合理的。（2）对于MT无法恢复的中小血管闭塞患者，替奈普酶0.25mg/kg可替代阿替普酶0.9mg/kg。（3）替奈普酶0.25mg/kg可作为阿替普酶0.9mg/kg无血管闭塞患者的替代药物。
结论：这些专家共识声明可以提供一个框架，以指导根据AIS患者的入院特征使用替奈普酶的临床决策过程。然而,现有数据有限，需要纳入正在进行的RCT或现实生活中的登记册。
