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Review
. 2023 Jul;54(7):1950-1953.
doi: 10.1161/STROKEAHA.123.042951. Epub 2023 May 25.

Tenecteplase in Acute Stroke: What About the Children?

Lisa R Sun  1 , Jenny L Wilson  2 , Michaela Waak  3 , Amy Kiskaddon  4   5 , Neil A Goldenberg  6 , Lori C Jordan  7 , Megan Barry  8
Affiliations
Review

Tenecteplase in Acute Stroke: What About the Children?

Lisa R Sun et al. Stroke. 2023 Jul.

Abstract

Tenecteplase is replacing alteplase as the fibrinolytic agent of choice for the acute management of ischemic stroke in many adult stroke centers due to practical and pharmacokinetic advantages in the setting of similar outcomes. Although thrombolytic use is increasing for acute childhood stroke, there is very limited experience with tenecteplase in children for any indication, and importantly, there are no data on safety, dosing, or efficacy of tenecteplase for childhood stroke. Changes in fibrinolytic capacity over childhood, pediatric pharmacological considerations such as age-specific differences in drug clearance and volume of distribution, and practical aspects of drug delivery such as availability in children's hospitals may impact decisions about transitioning from alteplase to tenecteplase for acute pediatric stroke treatment. Pediatric and adult neurologists should prepare institution-specific guidelines and organize prospective data collection.

Keywords: alteplase; child; fibrinolytic agent; ischemic stroke; tenecteplase.

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Conflict of interest statement

Disclosures Dr Sun receives research and salary support from the American Heart Association (Career Development Award 850044). Dr Goldenberg receives research and salary support from the National Institutes of Health, National Heart Lung and Blood Institute for investigation into venous thromboembolism in patients <21 years old. He receives or recently received consultancy fees from Anthos Therapeutics, Bayer, Boehringer-Ingelheim, Chiesi, Daiichi Sankyo, and the University of Colorado-affiliated Academic Research Organization CPC Clinical Research for roles in clinical trial planning or oversight committees in pharmaceutical industry-sponsored pediatric clinical trials of antithrombotics. The other authors report no conflicts.

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