• Amelia Nelson, Gregory Kelly, Richard Byyny, Catherine Dionne, Candice Preslaski, and Kevin Kaucher.
• Denver Health Medical Center, Department of Pharmacy, 777 Bannock ST. MC #0056, Denver, CO 80204, United States of America. Electronic address: amelia.nelson@me.com.
• Am J Emerg Med. 2019 Feb 1; 37 (2): 344-348.

IntroductionAcute ischemic stroke is a leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.ObjectiveThis review evaluates literature and utility of tenecteplase for treatment of acute ischemic stroke.DiscussionTenecteplase is modified, third generation fibrinolytic with greater specificity for fibrin bound clots. Current data in acute myocardial infarction suggest decreased bleeding events compared to alteplase. Multiple trials have investigated superiority of tenecteplase compared to tPA for treatment of acute ischemic stroke. Current guidelines designate tenecteplase as an alternative treatment for mild acute ischemic stroke patients based on recent literature.ConclusionRecent emerging literature and limited recommendation guidance from governing medical societies leave many emergency medicine providers to weigh benefit versus risk of fibrinolytic therapy and tenecteplase's place in therapy. This review evaluates the available literature regarding tenecteplase and its utility in the treatment of acute ischemic stroke patients.Copyright © 2018 Elsevier Inc. All rights reserved.

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