Effectiveness of Tenecteplase Versus Alteplase in Acute Ischemic Stroke Selected Subgroups of a Real-world Data Set
Luis Silva1, Shayan Khan1, Solmaz Ramezani Hashtjin1, Karen Shabano Stalin Durairaj1, Saketh Annam2, David Schneck1, Mark Fiecas1, Annette Xenopoulos-Oddsson1, Pramit Jagtap1, Cynthia Zheng1, Savannah Novy1, Salman Ikramuddin1, Abbey Staugaitis1, Christopher Streib1
1University of Minnesota, 2West Virginia University
Objective:
We studied the comparative effectiveness of Acute Ischemic Stroke (AIS) thrombolysis with Tenecteplase (TNK) versus alteplase (tPA) to understand the impact in understudied AIS subgroups.
Background:
TNK is increasingly utilized as an alternative AIS thrombolytic to tPA. Although many larger AIS trials have demonstrated the non-inferiority of TNK, real world data for many less common subgroups islacking.
Design/Methods:
We conducted a retrospective cohort analysis of AIS patients treated with thrombolysis within our health system. We utilized the Get With the Guidelines (GWTG) database to obtain patient demographic data. Additional variables and key outcomes (functional and radiographic) were abstracted independently from the electronic medical record. The primary outcome was the modified Rankin Scale (mRS) at 90 days assessed via ordinal logistic regression. Subgroups included Age (<60, 61-80, >80), location of vessel occlusion (Large or Medium vessel), thrombolysis in the extended time window (beyond 4.5 hours), treatment via telestroke, and thrombectomy.
Results:
500 consecutive AIS patients with complete outcome data were included ( Age: (Mean(SD)) 70 (16.05), 47.3% female, 71% TNK, 22% thrombectomy). In the adjusted ordinal logistic regression analysis, the TNK group had 1.00 odds of a worse mRS score (95% CI 0.57-1.74). Subgroup regression analysis demonstrated no heterogeneity in treatment effect.
Conclusions:
Our real world analysis revealed no difference in outcomes between TNK or tPA.We also did not find any differences in currently understudied subgroups. Our analysis may further support universal adoption of TNK for AIS thrombolysis.