10 Based on the above evidence, ASA guidelines, and reviews by other established authorities in the field, our multidisciplinary stroke committee determined that 0.25 mg/kg tenecteplase IV bolus in patients with and without large vessel occlusion (LVO) within 4.5 hours showed a trend toward increased early neurologic improvement and lower risk of intracerebral hemorrhage compared with alteplase. 1 , 2 , 11 Recent publication of the Extend IA TNK 2 study confirmed that 0.4-mg/kg IV compared with 0.25 mg/kg IV in treating patients with LVO did not improve reperfusion or functional outcomes. 12 This trial was also the first substantial head-to-head comparison of the 2 candidate doses of tenecteplase and suggested that the lower dose of 0.25 mg/kg was as effective and perhaps safer.
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