Comparison of tenecteplase versus alteplase in STEMI patients treated with ticagrelor: A cross-sectional study

Am J Emerg Med. 2022 Aug:58:52-56. doi: 10.1016/j.ajem.2022.05.021. Epub 2022 May 20.


Background: The effectiveness and safety of administration of ticagrelor simultaneously with fibrinolytic agents in STEMI patients remain unclear.

Objective: This study aimed to investigate the effectiveness and safety of tenecteplase against alteplase in patients with STEMI receiving a loading dose of ticagrelor.

Methods: We conducted a cross-sectional study in patients with STEMI who were reperfused with fibrinolytic. The study included 150 patients (ages 18 to 75 years) administered tenecteplase or alteplase and concomitantly given ticagrelor [180 mg loading dose, 90 mg bid (bis in die)]. Patients who had active major bleeding, died, and who were decided to have a CABG surgery as a result of coronary angiography were excluded. Patients who underwent facilitated-PCI with fibrinolysis continued to receive ticagrelor without switching to clopidogrel. The MACE (in-hospital death, TIMI flow grade, major bleeding) rates of the two groups were compared.

Results: The study consisted of 150 patients, comprising 99 (66%) men and 51 women (34%) with a mean age of 60,33 ± 13,83 years. Patients were divided into two groups according to the thrombolytic therapy: alteplase (n = 60) and tenecteplase (n = 90). The major adverse cardiac events (MACE) (45% vs 22.2%), bleeding (11.7% vs 2.2%), hypertension (51.7% vs 30%), atrial fibrillation (26.7% vs 12.2%), left ventricular hypertrophy (26.7% vs 10%), CRP (p < 0.001) were significantly higher and the recanalization (66.7% vs 85.4%), hematocrit (p = 0.03) were significantly lower in the alteplase group compared to the tenecteplase group. No significant differences were found between the two groups about in-hospital mortality (p = 0.151). Kaplan Meier analysis was performed in terms of MACE (TIMI flow grade 1, major bleeding, in-hospital mortality) rates during the follow-up period (Log-rank test, p = 0.032). Patients who received tenecteplase treatment had a lower MACE, according to a Kaplan-Meier analysis.

Conclusions: The administration of tenecteplase in STEMI patients who received a loading dose with ticagrelor resulted in a significant reduction in MACE compared to alteplase. Larger multi-center studies are warranted to investigate the effect of tenecteplase treatment on clinical results.

Keywords: Antiaggregant; Bleeding; STEMI; Thrombolytic treatment; Ticagrelor.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Hemorrhage / etiology
  • Hospital Mortality
  • Humans
  • Infant, Newborn
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention*
  • ST Elevation Myocardial Infarction* / surgery
  • Tenecteplase / therapeutic use
  • Ticagrelor / therapeutic use
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome
  • Young Adult


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Ticagrelor
  • Tenecteplase