Short-term outcomes of intravenous tenecteplase compared with alteplase for mild acute ischemic stroke

To investigate the short-term outcomes of intravenous tenecteplase compared with alteplase for patients with mild acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5 points).

We performed a retrospective analysis of 226 mild stroke patients in the Stroke Center Registry database who received intravenous thrombolysis from May 2010 to December 2023. The primary outcome was excellent functional prognosis (modified Rankin scale [mRS] score of 0-1) at discharge. The secondary outcomes were good prognosis (mRS 0-2) at discharge, early neurological improvement (ENI), early neurological deterioration (END), all intracranial hemorrhage and symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analyses were used to assess the independent factors of excellent outcome and END.

Excellent functional outcome at discharge occurred in 82.8 % of patients receiving tenecteplase and 56.4 % of patients receiving alteplase (adjusted OR 3.59, 95 % CI 1.62-7.97; P = 0.002). With respect to secondary outcomes, similar rates of good outcome, ENI, END, all intracranial hemorrhage and sICH were observed between the two groups before and after adjusting for confounding factors (all P > 0.05). Multivariate logistic regression analysis revealed that the door-to-needle time (DNT), baseline NIHSS score, and END were negatively associated with excellent outcome, and ENI was positively associated with excellent outcome. In addition, only DNT was independently associated with END (P < 0.05).

Tenecteplase was associated with a higher rate of excellent functional outcome at discharge compared to alteplase for mild stroke patients treated within 4.5 h of symptom onset.