Tenecteplase Versus Alteplase for Acute Stroke: Mortality and Bleeding Complications

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Intravenous thrombolysis is a cornerstone in acute ischemic stroke treatment.
• Alteplase has been the standard thrombolytic agent for decades.
• Tenecteplase offers potential logistical advantages and comparable efficacy/safety.

Purpose of the Study:

• To compare the efficacy and safety of tenecteplase versus alteplase in acute ischemic stroke.
• To evaluate outcomes including mortality, intracranial hemorrhage, and blood transfusions.
• To assess potential temporal differences in treatment outcomes.

Main Methods:

• Retrospective analysis of a large US database (TriNetX) including 54 academic medical centers.
• 3,432 patients treated with tenecteplase and 55,894 with alteplase were identified.
• Propensity score matching created a cohort of 6,864 evenly matched patients for comparison of 7- and 30-day outcomes.

Main Results:

• Tenecteplase was associated with significantly lower 30-day mortality (8.2% vs 9.8%) and reduced blood transfusions (0.3% vs 1.4%).
• No statistically significant difference in 30-day intracranial hemorrhage was observed in the overall 10-year cohort (3.5% vs 3.0%).
• A 2021-2022 subgroup analysis showed better survival and lower intracranial hemorrhage rates with tenecteplase.

Conclusions:

• Tenecteplase demonstrated a lower mortality rate and less significant blood loss in acute stroke treatment.
• While overall intracranial hemorrhage rates were similar, recent data suggests a potential benefit for tenecteplase.
• Favorable safety, mortality profiles, and operational advantages support preferential use of tenecteplase for ischemic stroke.