Abstract Details

Title Comparative Efficacy and Safety of Tenecteplase Versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-003

Objective To systematically evaluate and compare the efficacy, functional outcomes, and safety profiles of Tenecteplase and Alteplase in the management of acute ischemic stroke (AIS) using evidence from randomized controlled trials

Background Acute ischemic stroke (AIS) is a major global cause of death and disability. Tenecteplase, a modified tissue plasminogen activator, offers pharmacologic and practical advantages over Alteplase, including single-bolus administration and greater fibrin specificity. Recent FDA approval in 2025 highlights its potential as an alternative thrombolytic for AIS treatment.

Design/Methods A systematic search of MEDLINE, EMBASE, CENTRAL and SCOPUS was conducted up to October 2025 for Randomized Control Trials (RCTS). Meta-analysis was performed using Stata 18.0, and ROBS 2.0 assessed the risk of bias.

Results

A total of 2,896 studies were screened, and 18 randomized controlled trials met inclusion criteria, involving 11,347 patients (1,710 Tenecteplase, 6,841 Alteplase, 3,068 controls). Tenecteplase showed a significant survival benefit (OR = 0.07; 95% CI 0.02–0.12) and reduced mortality compared to Alteplase (OR = 0.49; 95% CI 0.21–0.78). Rates of symptomatic cranial hemorrhage were comparable (Tenecteplase OR = 0.12; 95% CI –0.29–0.54; Alteplase OR = 0.88; 95% CI –0.24–1.86). Functional recovery favored Alteplase, showing greater improvement on the modified Rankin Scale (OR = 0.27; 95% CI 0.11–0.65) and Barthel Index (OR = 0.48; 95% CI 0.37–1.32), while Tenecteplase showed modest, non-significant effects. Infection and adverse event rates were similar, though Tenecteplase showed slightly higher injection site reactions (RR = 0.63; 95% CI 0.42–1.62). Overall, both thrombolytics demonstrated comparable safety profiles.

Conclusions Tenecteplase showed superior survival with comparable safety to Alteplase, while Alteplase provided better functional recovery in acute ischemic stroke. Overall, the included studies had a low risk of bias, with adequate randomization and reliable outcome reporting, supporting the robustness of the findings

Authors/Disclosures
Shradha P. Kakde, MBBS PRESENTER	Dr. Kakde has nothing to disclose.
Meghana Chennupati, MBBS	Miss Chennupati has nothing to disclose.
Rakhshanda Khan, MBBS	Dr. Khan has nothing to disclose.
Harshawardhan D. Ramteke, Sr., MBBS	Dr. Ramteke has nothing to disclose.

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