Effects of Tenecteplase on vascular recanalization, clinical prognosis and safety evaluation in patients with acute ischemic stroke: a systematic review and meta-analysis

Abstract

Objective: To assess the effect and safety of Tenecteplase (TNK) on vascular recanalization, clinical prognosis and safety in patients with acute ischemic stroke (AIS). Methods: PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang Database and China Biomedical Literature Database (CBM) online database were searched for case-control trials in patients with AIS treated with TNK and alteplase. Between January 2010 and the present, the search period was limited. The data were collected separately by two researchers, and a meta-analysis of the collected data was conducted by RevMan5.3 statistical software using the Cochrane Handbook 5.3 standard for assessing bias risk. Results: Finally, 5 clinical control studies were contained. The total number of samples collected was 1569. In order to determine the improvement rate of early neurological function following treatment, an analysis of meta-analyses was conducted. Based on the fixed effect model analysis, the study group showed a noticeable improvement in early neurological function (P<0.05). In order to determine the reperfusion rate after thrombolysis for 24 hours, an analysis of meta-analyses was conducted. The fixed effect model analysis indicated that the reperfusion rate of the study group after 24 hours of thrombolysis was noticeably higher (P<0.05). In order to determine the proportion of cases with a Modified Rankin Scale (mRS) score ≤ 1 point 90 days after thrombolysis, an analysis of meta-analyses was conducted. Using the fixed effect model analysis, no statistically noticeable differences were found in the proportion of cases with 90dmRS score ≤ 1 after treatment (P>0.05). In order to determine the rate of symptomatic intracranial hemorrhage, an analysis of meta-analyses was conducted. There exhibited no statistically noticeable difference in the rate of symptomatic intracranial hemorrhage after treatment (P>0.05). In order to determine the incidence of bleeding, an analysis of meta-analyses was conducted. In effect model analysis, bleeding incidence after treatment was not noticeably different from baseline (P>0.05). In order to determine the mortality rate, an analysis of meta-analyses was conducted. No statistical difference was found in the mortality rate after treatment (P>0.05). Some of the distributions were asymmetric, suggesting that in the contained literature, a certain publication bias was present, which could be explained by the heterogeneity of studies and the small number of papers contained. Conclusion: TNK can noticeably enhance the early neurological function of patients with AIS, effectively improve the recanalization rate of blood vessels, promote the prognosis of patients, and do not increase the incidence of adverse events. The treatment deserves to be popularized in clinics. Study and follow-ups with higher methodological quality and a longer intervention period are required to achieve a greater degree of verification.