價Check for updatesEUROPEANGuidelineSTROKE JOURNALEuropean Stroke JoumalEuropean Stroke Organisation (ESO)2023.VdL.8()8-54European Stroke Organisation 2023Article reuse guidelines:expedited recommendation onsagepub.com/ournals-permissionsD0t10.117723969873221150022tenecteplase for acute ischaemic strokejournals.sagepub.com/home/esoSSAGESonia Alamowitch!,Guillaume Turc2.3.4.5,Lina Palaiodimou,Andrew Bivard7,Alan Cameron,Gian Marco De Marchis10,Annette Fromm,Janika Korv2,Melinda B Roaldsen!3,Aristeidis H Katsanos4 and Georgios Tsivgouliss*AbstractWithin the last year,four randomised-controlled clinical trials (RCTs)have been published comparing intravenousthrombolysis(IVT)with tenecteplase and alteplase in acute ischaemic stroke(AlS)patients with a non-inferiority designfor three of them.An expedited recommendation process was initiated by the European Stroke Organisation(ESO)andconducted according to ESO standard operating procedure based on the Grading of Recommendations,Assessment,Development and Evaluations(GRADE)framework.We identified three relevant Population,Intervention,Comparator,Outcome(PICO)questions,performed systematic reviews of the literature and meta-analyses,assessed the quality ofthe available evidence,and wrote evidence-based recommendations.Expert consensus statements were provided ifinsufficient evidence was available to provide recommendations based on the GRADE approach.For patients with AlS of<4.5h duration who are eligible for IVT,tenecteplase 0.25 mg/kg can be used as a safe and effective alternative to alteplase0.9 mg/kg(moderate evidence,strong recommendation).For patients with AlS of <4.5h duration who are eligible forIVT,we recommend against using tenecteplase at a dose of 0.40 mg/kg (low evidence,strong recommendation).Forpatients with AlS of <4.5h duration with prehospital management with a mobile stroke unit who are eligible for IVT,we suggest tenecteplase 0.25 mg/kg over alteplase 0.90 mg/kg (low evidence,weak recommendation).For patients withlarge vessel occlusion (LVO)AIS of <4.5h duration who are eligible for IVT,we recommend tenecteplase 0.25 mg/kgover alteplase 0.9 mg/kg(moderate evidence,strong recommendation).For patients with AlS on awakening from sleepor AlS of unknown onset who are selected with non-contrast CT,we recommend against IVT with tenecteplase 0.25 mg/kg(low evidence,strong recommendation).Expert consensus statements are also provided.Tenecteplase 0.25 mg/kg maybe favoured over alteplase 0.9 mg/kg for patients with AlS of <4.5h duration in view of comparable safety and efficacydata and easier administration.For patients with LVO AlS of<4.5 h duration who are IVT-eligible,IVT with tenecteplase0.25mg/kg is preferable over skipping IVT before MT,even in the setting of a direct admission to a thrombectomy-capableAP-HP,Service des Urgences Cerebro-Vasculaires,Hopital Pitie-Department of Neurology,Center for Neurovascular Diseases,Salpetriere,Hopital Saint-Antoine,STARE team,iCRIN,Institut duHaukeland
