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Updated: Jul 14, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Tenecteplase vs Alteplase and Time to Treatment for Acute Ischemic Stroke
Steven J Warach1, Jeremy M Weber2, Brooke Alhanti2
1Department of Neurology, Dell Medical School, The University of Texas at Austin and Ascension Texas, Austin.
JAMA Network Open
|July 13, 2026
Summary
Tenecteplase significantly reduced door-to-needle and door-in-door-out times in acute ischemic stroke patients compared to alteplase. This suggests tenecteplase offers workflow advantages for stroke thrombolysis.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Tenecteplase is an alternative to alteplase for acute ischemic stroke thrombolysis.
- Its impact on workflow metrics like door-to-needle time is not well-characterized.
Purpose of the Study:
- To compare door-to-needle and door-in-door-out times between tenecteplase and alteplase in US hospitals.
- To evaluate workflow efficiency for acute ischemic stroke treatment.
Main Methods:
- Cohort study using the Get With The Guidelines-Stroke registry (July 2020-June 2022).
- Compared workflow times (door-to-needle, door-in-door-out) between tenecteplase and alteplase treated patients.
- Used generalized linear mixed models for analysis.
Main Results:
- Tenecteplase showed significantly shorter mean door-to-needle times (-3.13 minutes) compared to alteplase.
- Tenecteplase also demonstrated shorter door-in-door-out times (-5.94 minutes) in transferred patients.
- Faster workflow metrics were observed for tenecteplase in thrombectomy patients.
Conclusions:
- Tenecteplase is associated with faster door-to-needle and door-in-door-out times than alteplase.
- These workflow advantages support the broader use of tenecteplase for stroke thrombolysis.
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