title: Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: a systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  Alteplase and tenecteplase are two widely used thrombolytic agents and are both approved for the treatment of acute myocardial infarction. These two molecules have increased fibrin specificity compared with older thrombolytics but distinct pharmacokinetic properties and may differ in terms of risks and benefits. We decided to review the available evidence comparing the safety and efficacy of these two molecules in acute coronary syndrome (ACS) or pulmonary embolism (PE).
  
  
  METHODS
  To compare the efficacy and safety profile of alteplase and tenecteplase, we systematically searched PubMed, Cochrane and Embase for randomized studies comparing weight-adjusted alteplase to weight-adjusted tenecteplase in patients with ACS or PE. The primary endpoint was the risk of major bleeding, and secondary endpoints were risk of intracranial haemorrhage (ICH), vessel recanalization and 30-day mortality.
  
  
  RESULTS
  Three studies including 17,325 patients with ACS were included in a quantitative meta-analysis. No study compared alteplase to tenecteplase in acute PE. Tenecteplase was associated with a statistically significant reduction of the risk of major bleeding compared to alteplase (RR = 0.79; 95% CI: 0.69-0.90,p= 0.0002). The risk of intracranial haemorrhage (RR = 0.96; 95% CI: 0.71-1.31,p= 0.82) and 30-day mortality (RR = 1.02; 95% CI: 0.9-1.15) were similar in patients treated with alteplase or tenecteplase. No difference was observed in the rate of vessel recanalization.
  
  
  CONCLUSIONS
  The available evidence suggests that tenecteplase is associated with a reduced risk of major bleeding compared to alteplase in ACS without evidence of reduced efficacy. These results are however mainly dependent on a single study.
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Guillermin
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: David Jun
authors.initials: DJ
authors.lastname: Yan
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.affiliation: Division of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Marti
keywords: acute coronary syndrome; alteplase; systematic review; tenecteplase; thrombolysis