Photo Credit: Mr. Suphachai Praserdumrongchai

The following is a summary of “Tenecteplase Versus Alteplase for Acute Stroke: Mortality and Bleeding Complications,” published in the December 2023 issue of Emergency Medicine by Murphy et al.

For decades, acute ischemic stroke has been treated with alteplase intravenous thrombolysis. The thrombolytic agent tenecteplase was cheaper and easier to administer than alteplase. Tenecteplase was equally effective and safe as alteplase for stroke. A large retrospective US database (TriNetX) was used to compare tenecteplase with alteplase for acute stroke in terms of mortality, intracranial bleeding, and acute blood transfusions. Researchers identified 3,432 tenecteplase and 55,894 alteplase stroke patients treated after January 1, 2012, in this retrospective investigation utilizing the TriNetX database of 54 academic medical centers/health care organizations in the US. 

Basic demographic information and 7 prior clinical diagnostic categories were used for propensity score matching to match 6,864 acute stroke patients equally. Death rates, cerebral hemorrhage, and blood transfusions (a symptom of severe blood loss) were tracked for each group over the next 7 and 30 days. Secondary subgroup analyses were performed on a cohort from 2021 to 2022 to examine whether acute ischemic stroke treatment timing affected outcomes. Tenecteplase had a considerably reduced death rate (8.2% vs. 9.8%; risk ratio [RR], 0.832) and risk of serious bleeding (blood transfusions, 0.3% versus 1.4%; RR, 0.207) than alteplase at 30 days following stroke thrombolysis. Tenecteplase did not significantly reduce intracranial hemorrhage at 30 days after thrombolytic agent administration in the larger 10-year data set of stroke patients treated after January 1, 2012. 

However, a subgroup study of 2,216 equally matched stroke patients treated from 2021 to 2022 showed higher survival and reduced intracranial bleeding than alteplase. In their big retrospective multicenter investigation incorporating real-world data from major health care organizations, tenecteplase for acute stroke reduced mortality, intracranial hemorrhage, and blood loss. The good mortality and safety profiles in the large investigation, earlier randomized controlled trial results, and operational benefits in quick dosing and cost-effectiveness suggested the preferred use of tenecteplase in ischemic stroke patients.

Source: sciencedirect.com/science/article/abs/pii/S0196064423002147