Tenecteplase (TNKase) may worsen functional outcomes in older patients with minor ischemic stroke

1. Tenecteplase (TNKase) improved early recanalization and short-term neurologic recovery, but in patients older than 80 years with minor ischemic stroke, it did not improve and may worsen 90-day functional outcomes.

2. In this older subgroup, tenecteplase was associated with more serious adverse events, especially hemorrhagic complications and stroke progression or recurrence, supporting standard care over thrombolysis in this setting.

Evidence Rating Level: 1 (Excellent) 

This post hoc age-stratified analysis of the TEMPO-2 randomized trial examined whether intravenous tenecteplase benefits older adults with minor ischemic stroke, a group for whom high-quality thrombolysis data remain limited. TEMPO-2 enrolled adults with minor deficits, baseline independence, and symptomatic intracranial occlusion or focal perfusion lesion within 12 hours of symptom onset, and compared tenecteplase 0.25 mg/kg with non-thrombolytic standard care. The primary outcome was a 90-day modified Rankin Scale responder analysis, and secondary outcomes included 90-day function and quality of life, early neurologic recovery, recanalization, and adverse events. Among 884 patients, 208 were older than 80 years. In this subgroup, tenecteplase was associated with worse functional outcomes, including lower rates of mRS 0–1 at 90 days compared with standard care (46.2% vs 59.8%; adjusted risk ratio 0.83, 95% CI 0.72–0.97). Although tenecteplase improved early vessel recanalization and short-term neurologic recovery in both older and younger patients, these early gains did not translate into better 90-day outcomes in those older than 80 years. Serious adverse events were also more frequent in the older tenecteplase group, particularly hemorrhagic events and stroke progression or recurrence. Overall, these findings do not support routine thrombolysis with tenecteplase for minor stroke in patients older than 80 years.

Click here to read the study in Neurology

Image: PD

©2026 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.