Tenecteplase for acute ischemic stroke presenting after 4.5 hours (TIMELESS trial)
Tenecteplase (TNKase or TNK) is genetically modified alteplase (tPA). Because it can be infused more rapidly than alteplase, TNK is gaining prominence as thrombolytic treatment for acute ischemic stroke, in patients presenting within 4.5 hours of their last time known to be well.
Limited data have suggested thrombolytics may be beneficial beyond 4.5 hours post-stroke, but those trials were conducted before mechanical thrombectomy (performed a.s.a.p. after thrombolysis) became standard care. The TIMELESS study was performed to test the question of whether TNK might help if administered later (more than 4.5 hours after the onset of stroke).
Patients (n=458) with occlusions of the middle cerebral artery or internal carotid artery presenting 4.5 to 24 hours after the onset of symptoms were randomized to TNK or placebo. About three-quarters also underwent thrombectomy. At 90 days, mortality was non-significantly higher in the TNK group (19.7%, versus 18.2%), as was symptomatic intracranial…
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