Coronary disease & ACSMeta-analysis
Intracranial haemorrhage following tenecteplase fibrinolysis for acute myocardial infarction
- Pooled individual patient data analysis of six randomised controlled trials
- logistic regression
- nomogram for individual risk prediction
Authors' conclusion
Dose reduction of TNK in older patients and SBP optimization before fibrinolytic administration represent modifiable strategies to potentially reduce ICH.
Study context
- Population
- ST-elevation myocardial infarction (STEMI) patients given weight-adjusted TNK (BP exclusion >180/110 mmHg) in ASSENT-2, ASSENT-3, ASSENT-3 PLUS, ASSENT-4 PCI, STREAM, STREAM-2
- Participants
- 15,954 participants · 6 RCTs
- Outcome
- Risk factors for ICH after TNK; clinical risk prediction tool
Pooled result
As reported in the abstract
ICH and its risk factors
Adjusted odds ratio (95% CI)P value
SBP, per 1 mmHg increase above 110 mmHg2% relative increase in ICH risk; risk accelerated sharply beyond 160 mmHg
1.02(1.01–1.03)
P < 0.0001Female sex49% increased ICH risk
1.49(1.06–2.11)
P = 0.023Body weight, per 5 kg decrease16% increased odds of ICH
1.16(1.03–1.30)
P = 0.014Each row per its own increment, as printed
- Multivariable model (age, sex, systolic blood pressure (SBP), body weight, TNK dose, age-dose interaction) · good discrimination
- C index 0.718 (95% CI 0.68–0.76)
- Patients developing intracranial haemorrhage (ICH)
- 169
- Increase in ICH likelihood per year of age, 30 mg TNK
- 1%
- Increase in ICH likelihood per year of age, 50 mg TNK
- nearly 7%
Original publication
Intracranial haemorrhage following tenecteplase fibrinolysis for acute myocardial infarction. Eur Heart J. Published 21 September 2026. doi:10.1093/eurheartj/ehag754
Summarised from the published abstract; every number is checked against it