To evaluate the effectiveness and safety of Tenecteplase (TNK) compared to alteplase in a community healthcare setting for treating ischemic stroke.
Approach:
Study Design: Multicenter, retrospective cohort study across 11 hospitals in West Central Florida, comparing TNK 0.25 mg/kg with standard-dose alteplase among adults with acute ischemic stroke.
Participants: 476 patients evaluated retrospectively, with 270 in the Alteplase arm and 206 in the TNK arm.
Outcomes: Primary outcome was early reperfusion prior to thrombectomy; secondary outcomes included door-to-needle time, NIHSS scores, discharge disposition, and safety outcomes.
Key Findings:
Early reperfusion occurred in 14.8% of TNK patients vs. 4.5% of alteplase patients (p = 0.008).
Median door-to-needle time was shorter with TNK (34 min) compared to alteplase (45 min, p < 0.001).
Good 90-day functional outcomes (mRS 0–2) were more common with TNK among LVO patients (47.3% vs. 29.3%, p = 0.031).
Symptomatic ICH rates were similar; overall ICH was less frequent with TNK (8.5% vs. 15.0%, p = 0.030).
Adjusted odds of early reperfusion were higher with TNK (OR 3.53 [95% CI, 1.20–10.40], p = 0.022).
Interpretation:
TNK 0.25 mg/kg IV was associated with higher pre-thrombectomy reperfusion, shorter door-to-needle times, comparable safety, and improved functional outcomes versus alteplase.
Limitations:
Retrospective design may introduce bias.
Findings are specific to a single health system and may not be generalizable.
Conclusion:
TNK 0.25 mg/kg is an effective alternative to alteplase for acute ischemic stroke treatment in community settings.
