Title : Safety and efficacy of tenecteplase versus alteplase for thrombolysis in acute ischemic stroke: Single center experience
Thrombolytic therapy has been the gold standard for treatment of ischemic stroke since 1996. While alteplase (tPA) remains the only FDA-approved thrombolytic for acute ischemic stroke, recent studies suggest that tenecteplase (TNK) may be a preferable alternative because of its advantageous drug characteristics and ease of administration.
The purpose of this study was to evaluate differences in clinical outcomes of patients treated before and after institutional transition from tPA to TNK as the thrombolytic agent of choice for acute ischemic stroke, which occurred in March 2022. The primary aim was to compare the effectiveness (i.e. improvement in functional status, defined as a Modified Rankin Scale (mRS) score of 0 or 1 at 90 days) and safety (i.e. side effects, incidence rate of spontaneous intracerebral hemorrhage (sICH) and mortality rate) of tPA versus TNK . Bivariate analysis was used to compare baseline characteristics across medication groups & for subgroup analysis of patients receiving mechanical thrombectomy. Multivariate tests were used for analysis of mRS scores.
A total of 148 consecutive acute ischemic stroke patients admitted to the Jamaica Hospital Medical Center were included. Seventy-five and 73 patients received tPA and TNK, respectively. At baseline, the tPA group had a significantly greater number of patients with mRS scores of 2+ compared to patients in the TNK group (34% vs. 18%, (X2(1) = 3.9, p = 0.05). No other differences in clinical or demographic variables were observed between groups at baseline. No differences were observed when comparing mRS scores at discharge, 30 days, or 90 days. In addition, rates of intracranial hemorrhage (tPA=3%, TNK=7%), length of stay (median tPA=4, TNK=4) and the total hospitalization cost (median tPA=$50,312, TNK=$45,900) were comparable between both groups. Although not significant, in-hospital mortality was higher among patients who received TNK versus tPA (12% and 9%, respectively). Among patients receiving mechanical thrombectomy, 10% of TNK had mRS <2 at discharge compared to 45% of tPA. However, this difference was not significant in bivariate analysis.
TNK and tPA showed comparable effectiveness and safety profiles at our institution. Though in-hospital mortality was slightly higher in those receiving TNK, this was not significant. Although small, the results from this real-world setting support the use of TNK as a viable option for thrombolytic treatment.