Abstract Details

Title Investigating Tenecteplase vs Alteplase for Treatment of Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 5-002

Objective To assess real-world outcomes in patients with acute ischemic stroke (AIS) treated with tenecteplase versus alteplase

Background Clinical trials and recent FDA approval have led to increasing use of tenecteplase in place of alteplase for treatment of AIS. Comparisons of outcomes in real-world settings remain ongoing.

Design/Methods This retrospective study included adults (aged ≥18 years) with AIS admitted to a US comprehensive stroke center: 63 received alteplase (01/05/2021-11/10/2023) and 47 received tenecteplase (03/18/2022-03/31/2024). Pearson chi-square tests were used to compare demographics, anti-coagulant use, stroke severity (NIHSS ≤5), stroke subtype, and intraarterial thrombectomy (IAT) following thrombolytic administration. Primary outcomes included functional independence at discharge (mRS 0-2), 90-day mortality, and intracerebral hemorrhage (ICH) illustrated on MRI. Successful reperfusion (TICI scores 2B, 2C, or 3) was assessed in patients who received IAT. Adjusted logistic regression models were used to assess the associations between tenecteplase and primary outcomes.

Results Among 110 patients (median age 70.5 years, 52.7% Male, 63.6% White) treated with either thrombolytic, demographics and anti-coagulant use were similar. Likewise, no differences were observed in stroke severity or subtype yet more patients given tenecteplase also received IAT (48.9% vs 25.4%; p=0.01) compared to patients given alteplase. In unadjusted analyses, there were no differences between patients given tenecteplase or alteplase in functional independence at discharge (43.5% vs 37.7%; p=0.55), 90-day mortality (13.6% vs 17.0%; p=0.65), ICH (10.6% vs 23.8%; p=0.08), or successful reperfusion (82.6% vs 87.5%; p=0.68). In models adjusted for IAT, the association between tenecteplase and ICH approached significance (OR: 0.29 [95% CI: 0.08-1.03]; p = 0.05).

Conclusions These findings support non-inferiority of tenecteplase compared to alteplase for patients admitted for AIS with a potential reduction in hemorrhagic risk. The recent FDA approval of tenecteplase for AIS underscores the importance of this research and supports our continued efforts to extend this investigation to a larger, matched sample.

Authors/Disclosures
Omar R. Hanbali, DO PRESENTER	Dr. Hanbali has nothing to disclose.
Renee Groechel, PhD	Dr. Groechel has received research support from National Institutes of Heath (NIH) Intramural Research Program (IRP).
Valerie S. Chaloka, MD	Dr. Chaloka has nothing to disclose.
Petros P. Keoseyan, DO, MBS	Dr. Keoseyan has nothing to disclose.
Ian Rankine, DO (HealthONE Neurology Residency)	Dr. Rankine has nothing to disclose.
Sierra R. Sandler, DO	Dr. Sandler has received personal compensation for serving as an employee of HCA HealthOne.
Teresa Zuber, NP, DNP	Dr. Zuber has nothing to disclose.
David Bar-Or	David Bar-Or has received intellectual property interests from a discovery or technology relating to health care.
Russell E. Bartt, MD, FAAN (Blue Sky Neurosciences)	Dr. Bartt has nothing to disclose.
Christian J. Burrell, MD (Blue Sky Neurology)	Dr. Burrell has nothing to disclose.

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