Tenecteplase and alteplase demonstrate similar efficacy for acute ischemic stroke

1. The usage of tenecteplase in patients with acute ischemic stroke was associated with similar effectiveness and safety compared with the use of alteplase. 

Evidence Rating Level: 2 (Good)

Current agents used in the thrombolytic management of acute ischemic stroke include tenecteplase and alteplase. Recent studies have shown that tenecteplase has at least similar effectiveness as alteplase in the management of acute ischemic stroke, yet there is a lack of real-world data comparing the two agents in routine clinical practice. This nationwide prospective cohort study therefore sought to investigate the safety and efficacy of tenecteplase compared to alteplase in the management of acute ischemic stroke. 79,550 patients (mean [SD] age, 69.6 [14.7] years; 52.4% male) with a final discharge diagnosis of acute ischemic stroke from the United States-based GWTG-Stroke registry were included for analysis. The primary endpoint for the study was functional independence on discharge as measured by the modified Rankin Scale (mRS) with safety endpoints including symptomatic intracranial hemorrhage (sICH) within 36 hours and in-hospital mortality. There was no difference in functional independence between the use of tenecteplase and alteplase (AOR, 1.00; 95% CI, 0.93-1.07). For safety outcomes, there was no difference in the rates of sICH (AOR, 0.96; 95% CI, 0.83-1.11) and in-hospital mortality (AOR, 0.95; 95% CI, 0.84-1.06) between those receiving tenecteplase and alteplase. Overall, this study found that the use of tenecteplase in patients with acute ischemic stroke was associated with similar effectiveness and safety outcomes as alteplase. 

Click to read the study in JAMA Network Open

Image: PD

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