Comparing Tenecteplase and Alteplase in Acute Ischemic Stroke Treatment: A Comprehensive Outcome Analysis
Sujani Bandela1, Gretchel Gealogo-Brown1, Sidarrth Prasad2, Shripal Gunna3, DaiWai Olson3, Lee Birnbaum1, Nathaniel Rodriguez3, Suzanne Stone3, Jane Anderson4, Sean Savitz5, Salvador Cruz-Flores6, Steven Warach7, Charlotte Rhodes8, Mark Goldberg9
1University of Texas Health Science, 2University of Texas, Southwestern Medical Center, 3UT Southwestern Medical Center, 4Veterans Health Administration, 5UT Houston, 6Paul L. Foster School of Medicine Texas Tech University Health Sciences Center, 7Dell Medical School, The University of Texas at Austin, 8UT Health San Antonio, 9Department of Neurology, UT Southwestern Medical Center
Objective:
Comparing Tenecteplase and Alteplase in Acute Ischemic Stroke Treatment throughout the state of Texas.
Background:
Tenecteplase (TNK) is emerging as a replacement for alteplase (ALT) to treat acute ischemic treatment (AIS).
Design/Methods:
The Lone Star Stroke registry combines data from 9 CSC and 4 PSC Texas hospitals mapped to GWTG variables. Cases include AIS patients who received ALT or TNK (10/1/19 – 3/31/23). Chi-square models with odds ratio (95% CI) were developed to explore primary and secondary outcomes
Results:
The 1140 patients who received ALT (476) or TNK (664) had similar median NIHSS scores [ALT = 9 (4-16), TNK = 8 (4-14); mean age [ALT = 66.7 (14.3), TNK = 67.8 (15.1); P= .20]; and proportion of males [ALT = 56.3%, TNK = 58.7%; P= .43]. The TNK cohort were more likely white (P<.001), and non-Hispanic (P<.001). EVT treatment were similar by group (ALT = 23.8%, TNK = 23.2%). Reperfusion (≥TICI 2B) was similar by group (ALT = 90.5%, TNK = 91.7%; P=0.37). However, odds of a discharge status (mRS < 3) were lower for ALT than TNK [34.7% vs 44.9%; 0.5 (0.38-0.68)]; similarly, the odds of having an independent ambulation status were lower for ALT than TNK [ 47.8% vs 54.9%; 0.75 (0.56 -0.9)]. Treatment related complications within 36 hours (including life threatening sICH and other serious events) was similar for those not undergoing EVT [ALT = 6 (1.3%), and TNK = 15 (2.3%), OR 1.81 (0.7-4.7)]; and for patients who underwent EVT [ALT = 3 (2.9%), and TNK = 6 (5.3%), OR 1.85 (0.5-7.6)].
Conclusions:
In this real-world Texas stroke cohort, TNK has a comparable safety profile with similar or improved functional outcomes when compared with ALT. Because centers transitioned to TNK during the study, these findings support hospitals transitioning to TNK without requiring major workflow modifications, ultimately leading to improved treatment outcomes.