Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials.

Humans Tenecteplase / therapeutic use Tissue Plasminogen Activator / therapeutic use Ischemic Stroke / drug therapy Randomized Controlled Trials as Topic Fibrinolytic Agents / therapeutic use Treatment Outcome Time-to-Treatment

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
12 Nov 2024
Historique:
medline: 16 10 2024
pubmed: 16 10 2024
entrez: 16 10 2024
Statut: ppublish

Résumé

The current European Stroke Organisation expedited recommendation on tenecteplase (TNK) for acute ischemic stroke (AIS) advocates that TNK 0.25 mg/kg can be used alternatively to alteplase (tissue plasminogen activator [TPA]) for AIS of <4.5 hours duration, based on a meta-analytical approach establishing noninferiority. Since the publication of these guidelines, 4 additional randomized controlled clinical trials (RCTs) have provided further insight. We conducted an updated systematic review and meta-analysis including all available RCTs that investigated efficacy and safety of TNK 0.25 mg/kg compared with TPA for the treatment of AIS within 4.5 hours of onset. The primary outcome was defined as the excellent functional outcome at 3 months (modified Rankin Scale [mRS] score 0-1), whereas good functional outcome (mRS score 0-2), reduced disability at 3 months (≥1-point reduction across all mRS scores), symptomatic intracranial hemorrhage (sICH), and 3-month mortality were evaluated as secondary outcomes. Pooled estimates were calculated with random-effects model. A prespecified subgroup analysis was performed stratifying for TNK formulation, that is, original TNK vs biocopy: recombinant human TNK tissue-type plasminogen activator that is available in China and has a different production process. Eleven RCTs were included comprising a total of 3,788 patients treated with TNK vs 3,757 patients treated with TPA. TNK was associated with higher likelihood of excellent functional outcome (risk ratio [RR] 1.05, 95% CI 1.01-1.10; The updated meta-analysis confirms similar safety between TNK 0.25 mg/kg and TPA, while showing that TNK is superior to TPA regarding excellent functional outcome and reduced disability at 3 months. These findings support transitioning to TNK in clinical practice.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
The current European Stroke Organisation expedited recommendation on tenecteplase (TNK) for acute ischemic stroke (AIS) advocates that TNK 0.25 mg/kg can be used alternatively to alteplase (tissue plasminogen activator [TPA]) for AIS of <4.5 hours duration, based on a meta-analytical approach establishing noninferiority. Since the publication of these guidelines, 4 additional randomized controlled clinical trials (RCTs) have provided further insight.
METHODS METHODS
We conducted an updated systematic review and meta-analysis including all available RCTs that investigated efficacy and safety of TNK 0.25 mg/kg compared with TPA for the treatment of AIS within 4.5 hours of onset. The primary outcome was defined as the excellent functional outcome at 3 months (modified Rankin Scale [mRS] score 0-1), whereas good functional outcome (mRS score 0-2), reduced disability at 3 months (≥1-point reduction across all mRS scores), symptomatic intracranial hemorrhage (sICH), and 3-month mortality were evaluated as secondary outcomes. Pooled estimates were calculated with random-effects model. A prespecified subgroup analysis was performed stratifying for TNK formulation, that is, original TNK vs biocopy: recombinant human TNK tissue-type plasminogen activator that is available in China and has a different production process.
RESULTS RESULTS
Eleven RCTs were included comprising a total of 3,788 patients treated with TNK vs 3,757 patients treated with TPA. TNK was associated with higher likelihood of excellent functional outcome (risk ratio [RR] 1.05, 95% CI 1.01-1.10;
DISCUSSION CONCLUSIONS
The updated meta-analysis confirms similar safety between TNK 0.25 mg/kg and TPA, while showing that TNK is superior to TPA regarding excellent functional outcome and reduced disability at 3 months. These findings support transitioning to TNK in clinical practice.

Identifiants

DOI: 10.1212/WNL.0000000000209903 PMID: 39413337
pubmed: 39413337
doi: 10.1212/WNL.0000000000209903
doi:

Substances chimiques

Tenecteplase WGD229O42W
Tissue Plasminogen Activator EC 3.4.21.68
Fibrinolytic Agents 0

Types de publication

Journal Article Systematic Review Meta-Analysis Comparative Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

e209903

Auteurs

Lina Palaiodimou (L)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0001-7757-609X

Aristeidis H Katsanos (AH)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0002-6359-0023

Guillaume Turc (G)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0001-5059-4095

Alexandros-Georgios Asimakopoulos (AG)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.

Dimitrios Mavridis (D)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.

Peter D Schellinger (PD)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0002-8517-0353

Aikaterini Theodorou (A)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0001-7229-2610

Robin Lemmens (R)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0002-4948-5956

Simona Sacco (S)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0003-0651-1939

Apostolos Safouris (A)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0002-9630-6949

Mira Katan (M)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0002-9265-8066

Amrou Sarraj (A)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0001-5726-4478

Urs Fischer (U)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0003-0521-4051

Georgios Tsivgoulis (G)

From the Second Department of Neurology (L.P., A.T., A. Safouris, G. Tsivgoulis), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Medicine (Neurology) (A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (Guillaume Turc), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G. Turc); INSERM U1266 (G. Turc); FHU NeuroVasc (G. Turc), Paris, France; Department of Primary Education (A.-G.A., D.M.), University of Ioannina, Greece; Department of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Germany; Department of Neurology (R.L.), University Hospitals Leuven; Division of Experimental Neurology (R.L.), Department of Neurosciences, KU Leuven-University of Leuven, Belgium; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Stroke Unit (A. Safouris), Metropolitan Hospital, Piraeus, Greece; Department of Neurology (M.K., U.F.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (A. Sarraj), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland.
ORCID: 0000-0002-0640-3797

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines du sang › Activateurs du plasminogène › Ténectéplase › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Facteurs biologiques › Facteurs de la coagulation sanguine › Activateur tissulaire du plasminogène › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Accident vasculaire cérébral ischémique › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Fibrinolytiques › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Tenecteplase vs Alteplase in Acute Ischemic...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Délai jusqu'au traitement › Tenecteplase vs Alteplase in Acute Ischemic...