What is the Difference Between Alteplase and Tenecteplase?

Alteplase and tenecteplase are both thrombolytic agents used for the treatment of acute ischemic stroke, but they have some differences in their properties and effects. Here are the main differences between the two:

1. Pharmacological properties: Tenecteplase is a genetically modified variant of alteplase with higher fibrin specificity and increased resistance to plasminogen activator inhibitor-1. This modification enables tenecteplase to be given as a single bolus, making it more convenient for prehospital or interhospital transfer.
2. Dosage: Alteplase is typically administered as a bolus, followed by an infusion, while tenecteplase is given as a single bolus. The most commonly studied doses of tenecteplase are 0.1 mg/kg, 0.25 mg/kg, and 0.4 mg/kg.
3. Safety: Tenecteplase has been associated with a lower risk of symptomatic intracerebral hemorrhage (sICH) compared to alteplase. In a large multicenter cohort, thrombolysis with tenecteplase was found to have a lower risk of sICH than alteplase.
4. Mortality and major bleeding: A study found that patients treated with tenecteplase had a significantly lower mortality rate (8.2% versus 9.8%) and lower risk of major bleeding, as measured by the frequency of blood transfusions (0.3% versus 1.4%), than alteplase at 30 days after thrombolysis for stroke.
5. Functional outcome: Two studies reported on functional outcome at 90 days, and there was no statistically significant difference between tenecteplase and alteplase.
6. Cost: Tenecteplase is currently cheaper than alteplase. A 50 mg vial of tenecteplase costs approximately $6,300, while a 100 mg vial of alteplase costs around $7,000.

In conclusion, tenecteplase appears to be a better thrombolytic agent for acute ischemic stroke when compared to alteplase due to its safety profile, lower risk of sICH, and cost-effectiveness. However, more research is needed to confirm these findings and determine the optimal dose of tenecteplase.

Comparative Table: Alteplase vs Tenecteplase

Alteplase and tenecteplase are both thrombolytic agents used for the treatment of acute ischemic stroke, but they have some differences in their properties and dosing. Here is a table summarizing the differences between the two:

Alteplase is the recombinant DNA technology-derived tissue plasminogen activator, while tenecteplase is a genetically modified variant of alteplase with a longer half-life, higher binding specificity to fibrin, and lower effect on systemic coagulation. Tenecteplase can be given as a single bolus, which is particularly helpful when a patient requires transfer from a primary to a comprehensive stroke center. Some studies have shown that tenecteplase is superior to alteplase in terms of early neurological improvement, recanalization of blood vessels, and functional independence. However, the difference in functional outcome at 90 days is not statistically significant between the two drugs.