In October 2022, our multicentered institution shifted from using alteplase to tenecteplase for the thrombolytic treatment of acute ischemic stroke (AIS). We aim to report and compare the incidence of hemorrhagic transformation and symptomatic intracranial hemorrhage (sICH) in patients treated with alteplase and tenecteplase at our institution.

Alteplase and tenecteplase are thrombolytic agents for treating AIS by dissolving thrombi, restoring blood flow, and reducing cerebral ischemia damage. Tenecteplase shows potential for faster thrombolysis and improved outcomes, making it an emerging alteplase alternative. While alteplase carries a 2-7% risk of (sICH), the impact of tenecteplase on hemorrhagic transformation is still debated and investigated in the literature.

Our study included 44 patients treated with alteplase from January to December 2021 and 41 patients treated with tenecteplase from October 2022 to September 2023. All included patients had AIS confirmed on magnetic resonance imaging or computerized tomography. We conducted a comparative analysis of the rates of hemorrhagic transformation with each thrombolytic agent, excluding patients who underwent thrombectomy following thrombolytic therapy.

In the alteplase group, 20% (9/44) experienced hemorrhagic transformation, while 19% (8/41) exhibited this complication in the tenecteplase group. However, sICH was observed in 9% (4/44) in the alteplase group and 4% (2/41) in the tenecteplase group.

In our small sample of patients, preliminary results indicate a slightly lower incidence of hemorrhagic transformation and sICH among patients treated with tenecteplase. While our limited sample of patients prevents us from drawing any definitive conclusion, further investigations with larger cohorts are required to provide more comprehensive insights into the comparative safety and efficacy of these thrombolytic agents in the context of AIS treatment. Nonetheless, our findings contribute valuable data to the ongoing discourse surrounding these critical treatment options.