Tenecteplase: expanding horizons in thrombolytic therapy across various clinical indications
Bibliographic record
Abstract
Intravenous thrombolytics remain the mainstay of treatment for ischaemic stroke and retain importance for selected patients with ST-elevation myocardial infarction and pulmonary embolism. Pharmacological and practical advantages of the fibrinolytic tenecteplase have recently led to a widespread shift in ischaemic stroke management. Meta-analysis of randomised trials demonstrated superiority of tenecteplase over alteplase in achieving excellent functional outcome after stroke (no disability). Trials have also extended the time window for thrombolytics in stroke to 24 hours, provided imaging demonstrates salvageable brain tissue. Although endovascular therapy is the most effective treatment for large vessel occlusion stroke, access remains limited to major metropolitan centres in developed nations. Trials suggest that thrombolytics add value, even in patients receiving endovascular therapy, and for many patients globally, intravenous thrombolytics are the only accessible reperfusion treatment. Tenecteplase is established as the preferred thrombolytic for selected patients with ST-elevation myocardial infarction, generally reserved for patients who cannot rapidly access percutaneous intervention following first medical contact. Notably, the dose used is twice that for stroke. Pre-hospital delivery of tenecteplase by paramedics is an important strategy in rural and remote areas. While patients with high-risk pulmonary embolism benefit from systemic thrombolysis, adjunctive tenecteplase in intermediate-risk pulmonary embolism has been associated with increased risk of major bleeding and haemorrhagic stroke. The practical advantages of bolus administration and having a single thrombolytic on formulary for all relevant indications have positioned tenecteplase as the leading thrombolytic agent in current practice. This review discusses the current evidence and treatment guidelines in this rapidly evolving field.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".