Safety and efficacy of intravenous tenecteplase in patients with acute ischemic stroke in extended time window: systematic review and meta-analysis

TNK 0.25 mg/kg appears to significantly achieve early neurological improvement with no effect in achieving excellent or favorable functional outcomes; however, it showed a significant increase in symptomatic intracranial hemorrhage. Patients who performed endovascular thrombectomy after administering TNK 0.25 mg/kg had statistically significantly higher rates of symptomatic intracranial hemorrhage; on the other hand, current evidence endorses the use of tenecteplase 0.25 mg/kg in patients with ischemic strokes whose baseline mRs ranges from 0 to 1. Further RCTs are necessary to validate these findings. Prospero registration number: CRD42025636473.