Evaluate the clinical outcomes of patients with acute ischemic stroke treated with Tenecteplase.

Alteplase is the only FDA approved thrombolytic treatment in acute ischemic stroke (AIS). Tenecteplase has shown similar efficacy and safety in multiple clinical trials and has the advantages of being given as a single bolus, having an increased resistance to plasminogen activator inhibitor-1, and a longer half-life, compared to Alteplase. Alongside many US Stroke Centers, our institution replaced Alteplase with Tenecteplase in February 2022 and we aim to report our experience.

This is an IRB approved retrospective study reviewing patients treated with Alteplase in 2021 and Tenecteplase from 2/2022 - 1/2023 at the Barrow Neurological Institute. Variables analyzed: demographics, admission and discharge National Institutes of Health Stroke Scale (NIHSS), door to needle time (DNT), door to imaging time (DTI), hemorrhagic complications, and discharge destinations. DNT for Tenecteplase and Alteplase were compared after excluding extreme outliers. Statistical analyses included use of Wilcoxon Rank Sum test and Exact test.

53 AIS patients received Tenecteplase; 40 (75%) received 0.25 mg/kg dose (maximum 25 mg) and 13 (25%) received 0.4 mg/kg dose (maximum 40 mg). The average age was 66 years and 28 (53%) of the subjects were male. 3 (5.7%) had hemorrhage on follow up CT scan. Patients were discharged to home (53%), acute rehabilitation facility (36%), skilled nursing facility (7.5%) and 3.8% died prior to discharge. The average NIHSS score improved from 8.4 to 3.3 at discharge (p < 0.05). The average DNT was 47 minutes for Tenecteplase (51 cases) and 56 minutes for Alteplase (55 cases)(p=0.034).  

Our study showed that Tenecteplase is efficacious and safe with a faster administration time compared to Alteplase. Although this is a retrospective study from a single center, our experience supports the switch from Alteplase to Tenecteplase for treatment of AIS.