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Updated: Jul 21, 2025

Prehospital Thrombolysis: A Manual from Berlin
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Tenecteplase real-world data: A three phase sequential comparison.

Anna Ranta1,2, Alicia Tyson1, Bhavesh Lallu3

  • 1Wellington Regional Hospital, Wellington, New Zealand.

European Stroke Journal
|July 25, 2023
PubMed
Summary
This summary is machine-generated.

Tenecteplase use in stroke thrombolysis showed better outcomes and faster treatment times compared to alteplase. These benefits were not due to temporal confounding, supporting tenecteplase

Keywords:
Strokereperfusiontenecteplasethrombolysis

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Area of Science:

  • Neurology
  • Pharmacology
  • Public Health

Background:

  • The New Zealand Central Region Stroke Network switched from alteplase to tenecteplase for stroke thrombolysis in 2020, then reverted to alteplase in 2021 due to drug supply issues.
  • This unplanned switch provided a unique opportunity to evaluate treatment efficacy and potential temporal confounding.

Purpose of the Study:

  • To assess the real-world effectiveness of tenecteplase compared to alteplase in stroke thrombolysis.
  • To determine if observed benefits of tenecteplase were influenced by temporal trends rather than the drug itself.

Main Methods:

  • A retrospective analysis of stroke patient data from January 2018 to December 2022 within the NZ Central Region Stroke Network.
  • Comparison of patient outcomes, including favorable modified Rankin Scale (mRS) scores, door-to-needle (DTN) time, needle-to-groin (NTG) time, and symptomatic intracerebral hemorrhage (sICH) rates.
  • Regression analyses were adjusted for key clinical factors and thrombectomy use.

Main Results:

  • 1121 patients received alteplase and 286 received tenecteplase.
  • Tenecteplase was associated with a higher odds of favorable functional outcome (aOR=1.43) and significantly shorter DTN and NTG times.
  • The rate of symptomatic intracerebral hemorrhage was lower with tenecteplase (aOR=0.29), and these findings persisted when comparing tenecteplase to the later alteplase period.

Conclusions:

  • The observed benefits of tenecteplase in a real-world stroke treatment setting are unlikely to be due to temporal confounding.
  • Tenecteplase demonstrates superior efficacy and safety profile compared to alteplase for stroke thrombolysis.
  • Findings support the continued use and consideration of tenecteplase in stroke management protocols.