Efficacy and Safety of Intravenous Thrombolysis with Tenecteplase in Patients with Wake-Up Branch Atheromatous Disease
Research article published in Translational stroke research (2026)
Abstract
Branch atheromatous disease (BAD), a subtype of acute ischemic stroke (AIS), is associated with a high risk of early neurological deterioration (END) and poor prognosis. Wake-up stroke (WUS), comprising 20%-30% of AIS cases, is typically excluded from thrombolysis because of unknown onset time. Using diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR) mismatch, we evaluated the efficacy and safety of Tenecteplase (TNK) thrombolysis in patients with BAD-related WUS. We retrospectively recruited 1,062 patients from seven Zhengzhou hospitals between January 2021 and June 2025. The patients received either TNK (n = 338) or dual antiplatelet therapy (n = 724). Propensity score matching (PSM; 1:1, caliper 0.02) yielded 292 matched pairs. Early neurological changes were evaluated using the National Institutes of Health Stroke Scale (NIHSS), and 90-day outcomes were evaluated using the modified Rankin Scale (mRS). After PSM, TNK significantly reduced the risk of END (odds ratio [OR] = 0.425, 95% confidence interval [CI]: 0.262-0.689; P < 0.001). Patients treated with TNK were more likely to achieve good functional outcomes (modified Rankin Scale [mRS] 0-1 and 0-2) with fewer poor outcomes (mRS ≥ 4). There were no significant differences in symptomatic intracranial hemorrhage, other bleeding events, or mortality among the groups. DWI/FLAIR mismatch-guided TNK thrombolysis appears to overcome the limitations of an unknown onset time in WUS and may counteract the progressive pathophysiology of BAD. TNK intravenous thrombolysis may be a safe and effective treatment for patients with wake-up BAD and DWI/FLAIR mismatches.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Peer-reviewed research on safety and infection-control considerations relevant to leech therapy and anticoagulation. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Este estudio multicéntrico retrospectivo comparó la trombólisis con tenecteplasa (TNK) frente a la terapia antiagregante plaquetaria dual en 1,062 pacientes con ictus al despertar por enfermedad ateromatosa de ramas, utilizando la discordancia DWI/FLAIR para seleccionar a los pacientes con tiempo de inicio desconocido; tras el emparejamiento por puntuación de propensión 1:1 (292 pares), TNK redujo significativamente el deterioro neurológico temprano (OR 0.425, IC 95% 0.262-0.689; P < 0.001) y mejoró los resultados funcionales a 90 días sin un aumento significativo en la hemorragia intracraneal sintomática. Para ASH, esto se enmarca en el panorama más amplio de trombolíticos/antitrombóticos que explica por qué se estudian los anticoagulantes derivados de sanguijuelas: documenta cómo se evalúa un agente dirigido a la fibrina en términos de beneficio frente a hemorragia, el mismo eje de riesgo-beneficio que rige cualquier molécula de la clase hirudin o hementin. La advertencia es sustancial: se trata de datos observacionales (no aleatorizados) de una sola región y no involucra sanguijuelas ni compuestos derivados de sanguijuelas, por lo que es solo un contexto de fondo, no evidencia para la hirudoterapia.
Citación
Efficacy and Safety of Intravenous Thrombolysis with Tenecteplase in Patients with Wake-Up Branch Atheromatous Disease.
Zhu et al. · Translational stroke research, 2026
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026