The objectives of this study were to determine if there is a significant difference between Alteplase and Tenecteplase in improvement of NIHSS, door to needle time (DTNT), disability at discharge determined by modified Rankin scale (mRS), and rate of intracranial hemorrhage (ICH).

There is growing interest in using Tenecteplase for acute ischemic stroke (AIS) treatment. Currently there is no clear consensus on its indication and dosage. We transitioned to Tenecteplase administration for AIS treatment in March 2021, at a dosage of 0.25 mg/kg.

A retrospective comparison analysis on the outcomes of AIS patients who were treated with Alteplase between April 2020 – March 2021 or Tenecteplase between April 2021 – March 2022.

Of 216 patients, 45.8% (n = 99) were given Alteplase and 54.1% (n = 117) were given Tenecteplase. There was no significant difference in baseline characteristics except hyperlipidemia, substance use, and history of smoking. No mean difference in mRS was measured at admission or discharge between Alteplase (1.42+/- 1.77) and Tenecteplase (1.32 +/- 1.56, p-value 0.703) and delta NIHSS between Alteplase and Tenecteplase (p-value 0.926). There was no difference in DTNT between both groups (p-value 0.172). Successful recanalization ratio was not significantly different. Symptomatic ICH was of no significant difference between the two groups: occurring in 5.05% patients receiving Alteplase and 5.13% patients receiving Tenecteplase (p-value 0.682). Rate of mortality was 13.13% (n = 13) in Alteplase and 11.11% (n = 13) in Tenecteplase, also of no significant difference (p-value 0.683). 

The results suggest that Tenecteplase has a similar efficacy and safety profile to Alteplase in real world practice. These findings are similar to results of previous randomized trials. At the dose of 0.25 mg/kg, Tenecteplase appears to be a reasonable alternative to Alteplase for use with acute ischemic strokes within 4.5 hours of onset.