HMN 2026: How Intravenous tenecteplase is not recommended for central retinal artery occlusion

Intravenous tenecteplase administered within 4.5 hours after onset of central retinal artery occlusion does not improve vision recovery at 30 days compared with oral aspirin, according to a study published in the Jan. 29 issue of the New England Journal of Medicine.

Stephen J. Ryan, M.D., from Oslo University Hospital in Norway, and colleagues conducted a phase 3, randomized, controlled trial involving adults with acute, nonarteritic central retinal artery occlusion who had symptom onset within 4.5 hours before treatment. Patients at 16 sites in six countries were randomly assigned to receive intravenous tenecteplase and oral placebo or intravenous placebo and oral aspirin (40 and 38 individuals, respectively). Vision recovery was assessed as the primary end point, defined as a best corrected visual acuity (BCVA) in the affected eye of up to 0.7 logMAR at 30 days.

The researchers found that 20% and 24% of patients in the tenecteplase and aspirin groups, respectively, had vision recovery at 30 days (risk difference, ?3.7 percentage points; 95% confidence interval, ?22.0 to 14.7; P = 0.69). With regard to secondary visual end points of a BCVA of up to 0.5 logMAR, mean improvement in BCVA, and perimetry score at 30 days, no substantial difference was seen between the groups. A greater incidence of adverse events was seen in the tenecteplase group, including one fatal intracranial hemorrhage.

“These findings do not support the routine use of thrombolytic therapy to treat central retinal artery occlusion,” the authors write.

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