Safety aspects of transitioning from alteplase to tenecteplase in the treatment of acute ischemic stroke – a narrative review
Authors:
V. Fišera 1; V. Šredlová 2,3; D. Černík 4,5
Authors‘ workplace:
Úsek ředitele UL, Masarykova nemocnice v Ústí nad Labem o. z., Krajská zdravotní, a. s.
1; Fakulta zdravotnických věd Univerzity Palackého v Olomouci
2; Klinika urgentní medicíny, Masarykova nemocnice v Ústí nad Labem o. z., Krajská zdravotní, a. s.
3; Komplexní cerebrovaskulární centrum, Neurologické oddělení, Masarykova nemocnice v Ústí nad Labem o. z., Krajská zdravotní, a. s
4; Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc
5
Published in:
Cesk Slov Neurol N 2026; 89(5): 290-294
Category:
Review Article
doi:
https://doi.org/10.48095/cccsnn2026290
Overview
Introduction: Intravenous thrombolysis (IVT) is the standard of care for acute ischemic stroke (AIS). Transitioning from alteplase to tenecteplase offers significant logistical advantages but requires a managed change of the clinical process. Objective: The aim of this study was to summarize available evidence on the efficacy and safety of IVT in AIS treatment, focusing on the safety risks associated with the transition from alteplase to tenecteplase, and to identify critical process points leading to medication errors. Methods: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases for the period 2015–2025, focusing on clinical outcomes, safety, and medication errors associated with thrombolytic therapy. Concurrently, a structured qualitative process risk analysis was performed, inspired by the principles of the Failure Mode and Effects Analysis (FMEA), within the clinical practice of a comprehensive stroke center. The analysis focused on the stages of indication, dose calculation, preparation, and drug administration. Results: Available literature supports that tenecteplase is non-inferior to alteplase regarding clinical efficacy and the incidence of symptomatic intracerebral hemorrhage. A key identified safety risk is the confusion of agents and dosing regimens, where applying the alteplase protocol to tenecteplase can lead to severe overdosing. Key contributing factors include high cognitive workload of personnel, visual similarity of the products (look-alike drug errors), and insufficient technical and procedural safeguards. Conclusion: A safe transition to tenecteplase requires a managed clinical process change, encompassing technical, procedural, and educational measures. Quality management represents a key partner for clinicians in establishing systemic barriers and ensuring patient safety during the implementation of new therapeutic standards.
Keywords:
acute ischemic stroke – alteplase – medication error – quality management – patient safety – tenecteplase
Sources
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2026 Issue 5
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