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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombus Migration After Tenecteplase Versus Alteplase in Acute Large Vessel Occlusion
Lu Wang1, Fuxia Yang1, Xiao Wu1
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Journal of Stroke
|June 4, 2026
Summary
Tenecteplase more effectively induced thrombus migration in large vessel occlusion (LVO) stroke patients compared to alteplase, especially within 60 minutes. This thrombus migration was linked to better functional outcomes, supporting tenecteplase use in bridging therapy.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Intravenous thrombolysis (IVT) in large vessel occlusion (LVO) stroke can alter thrombus location, but its clinical significance is not fully understood.
- Understanding post-IVT thrombus dynamics is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare thrombus dynamics after IVT between tenecteplase and alteplase in LVO patients.
- To assess the association between thrombus dynamics and 3-month functional outcomes.
Main Methods:
- Retrospective analysis of prospectively collected multicenter data from LVO patients undergoing bridging therapy.
- Classification of thrombus dynamics into resolution, migration, or stability.
- Propensity score matching and weighting to balance baseline characteristics between treatment groups.
Main Results:
- Tenecteplase showed a significantly higher incidence of thrombus migration compared to alteplase (19.3% vs. 11.3%).
- This advantage for tenecteplase was pronounced with IVT-to-puncture times under 60 minutes.
- Thrombus migration was independently associated with improved functional outcomes (OR: 1.62) and tenecteplase use with better functional independence (OR: 1.43).
Conclusions:
- Tenecteplase is more effective than alteplase in inducing thrombus migration, particularly when administered within 60 minutes.
- Thrombus migration is a predictor of improved functional independence in LVO stroke patients.
- These findings suggest tenecteplase may be preferred for bridging therapy in LVO.
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