Tenecteplase Versus Alteplase: An Improved Standard for Stroke Treatment?

In a study, published in Annals of Emergency Medicine, researchers compared outcomes of intravenous thrombolysis with either tenecteplase or the current standard, alteplase, in initial treatment of acute ischemic stroke.

Lead author of the study, Luke Murphy, reported initial stroke treatment with tenecteplase had lower rates of mortality, intracranial hemorrhage, and acute blood transfusion compared with alteplase. The authors noted their findings are in line with prior trials that showed tenecteplase had similar safety and efficacy but superior logistics compared with alteplase.

The study reviewed 3432 patients treated with tenecteplase and 55894 treated with alteplase for stroke at 54 centers after January 1, 2021 from within the retrospective TriNetX database.

Authors Prefer Tenecteplase to Alteplase

The final analysis was performed on propensity score-matched groups of 3432 patients each. Researchers assessed mortality, intracranial hemorrhage, and blood transfusions over the 7-day and 30-day periods following thrombolysis for stroke treatment.

At day 30, authors stated patients treated with tenecteplase had a significantly lower mortality rate (8.2% vs 9.8%; risk ratio [RR], 0.832), and reduced risk of major bleeding events as defined by frequency of blood transfusions (0.3% vs 1.4%; RR, 0.207).

The report noted that the primary cohort did not show a statistically significant difference in 30-day intracranial hemorrhage incidence (3.5% vs 3.0%; RR, 1.185. However, in a subgroup analysis of patients treated from 2021 to 2022, authors stated those treated with tenecteplase demonstrated improved survival and reduced intracranial hemorrhage compared with those treated with alteplase.

Overall, the researchers concluded that “the favorable mortality and safety profiles observed in this large study, taken together with previous randomized controlled trial data and operational advantages in rapid dosing and cost-effectiveness, all support the preferential use of tenecteplase in patients with ischemic stroke.”

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