Bayesian network Meta-analysis of efficacy and safety of different doses of tenecteplase in the treatment of acute ischemic stroke
Objective:To compare the efficacy and safety of different doses of tenecteplase vs alteplase for the treatment of acute ischemic stroke(AIS)through a network Meta-analysis of all published randomized controlled trials(RCTs).Methods:RCTs about the efficacy and safety of tenecteplase in the treatment of AIS were collected from CNKI,VIP,Wanfang Data,PubMed,Cochrane Library,Embase and Web of Science from the inception to July 2023.Two evaluators independently screened the literature,extracted data from the literature,evaluated the literature with Cochrane evaluation tool,and then conducted Meta-analysis by using RevMan 5.3,Rstudio and Stata 17 software.Results:A total of 5352 patients were enrolled in 12 RCTs,including 2916 patients in tenecteplase group(54.48%)and2436 patients in ateplase group(45.52%).Direct Meta-analysis showed that 0.25mg·kg-1 tenecteplase was effective in recanalization[OR=3.27,95%CI=(1.66~6.41),P=0.000 6]and excellent functional outcome after 3 months[OR=1.18,95%CI=(1.03~1.35),P=0.02];0.4 mg·kg-1 tenecteplase could increase symptomatic intracranial hemorrhage[OR=2.23,95%CI=(1.04~4.80),P=0.04];the network Meta-analysis also showed that 0.4 mg·kg-1 tenecteplase was significantly associated with the incidence of symptomatic intracranial[OR=2.7,95%CI=(1.2~7.6)].Conclusion:Compared with 0.9 mg·kg-1 alteplase,0.25 mg·kg-1 tenecteplase can provide more benefits,while 0.4 mg·kg-1 tenecteplase can increase the risk of symptomatic intracranial hemorrhage.This analysis provides reliable evidence for the treatment of AIS,but high-quality RCTs are needed to validate the findings.