Tenecteplase vs Alteplase in Mechanical Prosthetic Heart Valve Thrombosis: The TENET Randomized Clinical Trial.

Summary

In 83 patients with obstructive mechanical prosthetic valve thrombosis, tenecteplase achieved higher complete thrombolytic success (97.5% vs 81.5%) and shorter hospital stay (median 4.1 vs 6.5 days) than alteplase, with similar adverse event rates.

Key Findings

• Complete thrombolytic success: 97.5% with tenecteplase vs 81.5% with alteplase (RR 1.18; 95% CI 1.03–1.39; P=.02 for noninferiority).
• Shorter hospital stay with tenecteplase (median 4.1 vs 6.5 days; P<.001).
• Similar rates of major and minor adverse events between groups.

Clinical Implications

Tenecteplase can be considered a front-line thrombolytic for obstructive mechanical valve thrombosis, potentially reducing hospital LOS and streamlining care, especially where infusion infrastructure is limited.

Limitations

• Single-center, open-label trial with modest sample size
• Short-term outcomes; no long-term follow-up on valve function or recurrence

Future Directions

Multicenter trials to confirm efficacy and safety, define optimal dosing in diverse valve positions, and assess long-term outcomes and cost-effectiveness.