Tenecteplase versus alteplase after acute ischemic stroke at high age

Area of Science:

• Neurology
• Geriatrics
• Pharmacology

Background:

• Stroke incidence rises with age, posing significant challenges in geriatric populations.
• Alteplase is the sole approved thrombolytic agent for ischemic stroke, including individuals aged 80 and older.
• The study addresses the need for comparative data on newer thrombolytic options in this vulnerable demographic.

Purpose of the Study:

• To compare the efficacy and safety of tenecteplase versus alteplase in patients aged 80 years and above with ischemic stroke.
• To evaluate functional outcomes, intracranial hemorrhage rates, and mortality between the two treatment groups.

Main Methods:

• Analysis of data from the Norwegian Tenecteplase Stroke Trial, a randomized controlled trial.
• Inclusion of 273 patients aged 80 years and older.
• Intention-to-treat analysis of functional outcomes (modified Rankin Scale 0-1) at 3 months, symptomatic intracranial hemorrhage, and mortality.

Main Results:

• No significant differences in excellent functional outcome (modified Rankin Scale 0-1) at 3 months between tenecteplase (43.1%) and alteplase (39.9%) groups (OR 1.14, p=0.59).
• Similar rates of symptomatic intracranial hemorrhage (8.5% vs 7.0%, OR 1.23, p=0.65) and 3-month mortality (14.3% vs 15.3%, p=0.84) were observed.
• Excluding stroke mimics, tenecteplase showed a trend towards better functional outcomes (44.1% vs 34.4%, OR 1.50, p=0.12).

Conclusions:

• Tenecteplase and alteplase demonstrated comparable efficacy and safety profiles in patients aged 80 years and older with ischemic stroke.
• The findings suggest that tenecteplase is a viable alternative to alteplase in this elderly population.
• Further research may explore potential benefits in specific subgroups, such as excluding stroke mimics.