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A Comparative Study of Hemorrhagic Conversion Patterns After Stroke Thrombolysis With Alteplase Versus Tenecteplase
Mohamad Ezzeldin1, Courtney Hill2, Ali Kerro3
1Clinical Sciences, University of Houston, Houston, USA.
Cureus
|October 20, 2023
Summary
Tenecteplase showed a higher rate of symptomatic intracranial hemorrhage (sICH) compared to alteplase in acute ischemic stroke (AIS) patients, though not statistically significant. A significant increase in severe hemorrhagic conversion (HBC-3) was observed with tenecteplase.
Area of Science:
- Neurology
- Pharmacology
- Radiology
Background:
- Tenecteplase is a preferred thrombolytic for acute ischemic stroke (AIS).
- Contradictory data exist regarding tenecteplase's intracranial hemorrhage (ICH) risk.
- Alteplase is the established standard for comparison.
Purpose of the Study:
- To compare the incidence and patterns of symptomatic intracranial hemorrhage (sICH) after tenecteplase versus alteplase in AIS patients.
- To analyze radiographic bleeding patterns using the Heidelberg Bleeding Classification (HBC).
Main Methods:
- Retrospective cohort study across 15 Texas stroke centers.
- Data collected before and after switching from alteplase to tenecteplase.
- Primary endpoint: sICH incidence (SITS-MOST/ECASS-3 criteria).
- Secondary endpoint: Radiographic hemorrhage patterns (HBC).
Main Results:
- 431 patients included: 216 alteplase, 215 tenecteplase.
- sICH rates: 3.2% alteplase vs. 6.5% tenecteplase (OR 1.44, P=0.41).
- Increased NIHSS score was a significant predictor of sICH (P=0.04).
- Tenecteplase showed a statistically significant increase in HBC-3 hemorrhages (P=0.040).
Conclusions:
- Tenecteplase was associated with a higher, though not statistically significant, rate of sICH compared to alteplase.
- A statistically significant increase in severe hemorrhagic conversion (HBC-3) was observed with tenecteplase.
- Further research is needed to confirm findings and identify predictive risk factors for sICH.
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