Safety and Effectiveness of Routine Tenecteplase Use in a Large Telestroke Network

Tenecteplase is an emerging alternative to Alteplase in the management of acute ischemic stroke (AIS). Strong evidence supports the noninferiority of Tenecteplase compared with Alteplase in AIS. Tenecteplase is often preferred due to its affordability, ease of administration, and superior recanalization potential in large vessel occlusion. In this study, we report on the safety and effectiveness of routine Tenecteplase use in a large telestroke network in eastern India.

This retrospective observational study analyzes patient records collected under the Swasthya Ingit Telestroke Program in West Bengal, India. AIS patients who underwent thrombolysis in the 41 hospitals of the Swasthya Ingit Telestroke Network between January 2022 and December 2024 were included in this study. Patients receiving Tenecteplase were compared with those receiving Alteplase. The percentage of patients achieving a good outcome (defined as a score of 0 to 2 on the modified Rankin scale at 90 d), the rate of symptomatic intracranial hemorrhage, and all-cause mortality within 3 months were the main parameters of comparison between the 2 thrombolytic agents.

A total of 1526 patients were included in this study. Of these, 1389 patients received Tenecteplase, while 137 patients received Alteplase. Mixed-effects multivariable logistic regression did not demonstrate any association between the thrombolytic agent used and favorable outcomes [Tenecteplase odds ratio: 1.03 (95% CI: 0.56-1.87), P =0.93], symptomatic intracranial hemorrhage [Tenecteplase odds ratio: 0.63 (95% CI: 0.21-1.87), P =0.41], or all-cause mortality [Tenecteplase odds ratio: 0.54 (95% CI: 0.24-1.24), P =0.15].

The routine use of Tenecteplase for managing acute ischemic stroke appears to be safe and effective in real-world practice.