Background and Purpose-Tissue plasminogen activator (tPA) is an effective t
reatment for stroke, but its utility is limited by fear of cerebral hemorrh
age. Tenecteplase (TNK), a genetically modified form of wild-type tPA, exhi
bits a longer biological half-life and greater fibrin specificity, features
that could lead to fewer cerebral hemorrhages than wild-type tPA in stroke
patients.
Methods-We injected radiolabeled blood clots into the cerebral circulation
of New Zealand White rabbits, One hour later, we administered tPA (n=57), 0
.6 mg/kg TNK (n=43), 1.5 mg/kg TNK (n=27), or vehicle control (n=37). A bli
nded observer examined the brains for macroscopic hemorrhage using a semiqu
antitative score. We estimated thrombolysis by assessing the amount of radi
olabel remaining in the cerebral vessels postmortem.
Results-Both wild-type tPA and TNK caused thrombolysis in most subjects. He
morrhage was detected in 26% (6/23) of the control group, 66% (27/41) of th
e wild-type tPA group, 55% (16/29) in the 0.6-mg/kg TNK group, and 53% (9/1
7) in the 1.5-mg/kg TNK group (P<0.05, <chi>(2) test). The tPA group was st
atistically significantly different from the control group, but the TNK and
tPA groups did not differ from each other. Neither TNK nor tPA affected th
e size of the hemorrhages.
Conclusions-TNK shows comparable rates of recanalization compared with wild
-type tPA in a model of embolic stroke. While tPA increases hemorrhage rate
, the hemorrhage associated with TNK treatment is not statistically differe
nt compared with controls or the tPA group. These findings suggest that TNK
shows promise as an alternative thrombolytic treatment for stroke, but we
could not demonstrate improved safety compared with wild-type tPA.