Summary of COVID-19 tenecteplase studies
1. Poor et al., Tenecteplase With Concomitant Anticoagulation for Acute Respiratory Failure in Patients With COVID-19: A Randomized Controlled Trial
13 patient tenecteplase late treatment RCT: 25% higher mortality (p=1), 38% lower progression (p=0.59), and 15% shorter hospitalization (p=0.82).RCT 13 hospitalized COVID-19 patients with acute respiratory failure showing no significant difference in mortality or respiratory outcomes with tenecteplase plus heparin versus placebo plus heparin. At 28 days, 63% of tenecteplase patients were alive and free from respiratory failure compared to 40% in placebo group (p=0.43), with mortality rates of 25% versus 20% respectively (p=1.0). Major bleeding occurred in 25% of tenecteplase patients versus 20% of placebo patients, with no intracranial hemorrhages in either group. The study was severely underpowered due to early termination from poor enrollment (planned 60 patients, enrolled 13), making the results unreliable for drawing meaningful conclusions. Authors hypothesize that tenecteplase's resistance to PAI-1 and ability to be used with concomitant heparin may provide benefits for COVID-19 patients with pulmonary microthrombosis where anticoagulation alone has proven insufficient.
Feb 2024, Cureus, https://www.cureus.com/articles/225403-tenecteplase-with-concomitant-anticoagulation-for-acute-respiratory-failure-in-patients-with-covid-19-a-randomized-controlled-trial, https://c19p.org/poor