Intracranial and Extracranial Systemic Complications with Alteplase vs Tenecteplase among Large Vessel Occlusion Stroke Patients Undergoing Thrombectomy
Veronica Bohl1, Tyler Bielinski1, Kelsey Kline1, Grant Badger1, Prateeka Koul2, Anthony Noto2, Clemens Schirmer2, Philipp Hendrix2
1Geisinger Commonwealth School of Medicine, 2Geisinger Medical Center
Objective:
To compare rates of intracranial hemorrhages (ICH) and extracranial systemic complications between Tenecteplase (TNK) and Alteplase (TPA) in large vessel occlusion stroke (LVOS) patients referred for thrombectomy.
Background:
Adverse events following intravenous thrombolysis (IVT) include ICH, extracranial bleeding complications, and systemic complications such as angioedema.
Design/Methods:
We conducted a retrospective review of acute ischemic stroke patients (>18 years) treated with IVT and emergent endovascular treatment (EVT) between January 2020 and May 2024 (n=280). Patients were divided into two cohorts based on thrombolytic agent received: TNK (n=181) or TPA (n=99). Intracranial hemorrhage was classified according to the Heidelberg Bleeding Classification. Rates of any ICH, parenchymal hematomas types 1 and 2 (PH type 1 and 2), subarachnoid hemorrhage (SAH), and symptomatic ICH (sICH) were assessed. Systemic complications included access-site hematomas, retroperitoneal hematoma, gastrointestinal bleeding, and angioedema. Comparative statistical analyses were performed to evaluate complication rates across the two thrombolytic groups.
Results:
Of the 280 patients, 181 (64.6%) received TNK and 99 (35.4%) received TPA. Any ICH was observed in 43.4% of TPA and 38.9% of TNK cases (p=0.524). PH type 1 and 2 occurred in 13.1% of TPA and 12.8% of TNK cases (p=1.000). SAH was noted in 6.1% of TPA and 7.2% of TNK cases (p=0.808). sICH occurred in 2.0% of TPA and 2.8% of TNK patients (p=1.000). Multivariable analysis showed no significant association between thrombolytic type and occurrence of any ICH, PH, SAH, or sICH. Access-site hematomas were comparable between TNK (9.8%) and TPA (6.4%) (p=0.343). No retroperitoneal hematoma or gastrointestinal bleeding was reported. Angioedema was observed in 2.0% of TPA and 1.1% of TNK patients (p=0.616).
Conclusions:
The rates of intracranial hemorrhage and systemic complications were comparable between TNK and TPA groups. Therefore, TPA and TNK appear to have similar safety profiles in LVOS patients undergoing EVT.
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