systematic review and meta-analysis of the safety and effectiveness of tenecteplase versus alteplase in treatment of patients with st-elevation myocardial infarction

Background & objective: if primary angioplasty is not available, thrombolytic therapy is an appropriate option for the treatment of acute myocardial infarction (ami) in the early hours after the beginning of the signs. this study aimed to assess the safety and effectiveness of tenecteplase (tnkase) vs. alteplase in the treatment of st-elevation myocardial infarction (stemi). materials & methods: pubmed, cochrane library, and web of science were searched for the safety and clinical effectiveness of tnkase vs. alteplase, and a manual search was performed among the american, european, and iranian cardiovascular journals. randomized clinical trials (rcts) that included comparisons of tnkase with alteplase alone or with other drugs in stemi patients published in english, persian, and korean languages were included. two authors independently assessed the eligibility and quality of rcts. finally, the data were analyzed in review manager version 5.3. results: there was no statistically significant difference between tnkase and alteplase in the risk of 30-day mortality (rr=1.01; 95% ci: 0.89-1.13; p=0.82). the risk of reinfarction, cardiogenic shock, intracranial hemorrhage (ich), stroke, and minor bleeding was similar in ami patients treated with both drugs. tnkase was associated with a statistically significant reduction of total bleeding (p=0.0003) and major bleeding (p=0.0003). conclusion: in comparison with alteplase, tnkase is recommended due to its easier use and higher safety in reducing the risk of bleeding.