To determine whether tenecteplase use for acute ischemic stroke resulted in any difference in rate of clinical outcomes when compared to alteplase.

Tenecteplase is a thrombolytic with higher fibrin selectivity than alteplase and has the added advantage of single bolus dosing. For this reason, it has become an attractive alternative for stroke patients who meet criteria for thrombolysis.

This was a retrospective review of our hospital system’s electronic medical record for all strokes that presented during calendar years 2020 and 2021, approved by our institutional IRB. Baseline demographics including age, race, sex, and income levels were collected, as were baseline comorbidities. 

A total of 173,033 acute ischemic strokes occurred amongst our hospital network of 178 emergency departments. 344 patients received tenecteplase, 16,219 received alteplase, and 156,470 received no thrombolytic. The median age (68 years), sex (50% female), and income levels were similar across the 3 groups.  There were significantly more persons of Black race in the tenecteplase group (P= 0.0005). The 3 groups had similar frequencies of co-morbidities including atrial fibrillation (27%, 23%, 22%), obstructive sleep apnea (5%, 5%, 4%), diabetes (36%, 36%, 38%), prior stroke (13%, 13%, 15%), and hypothyroidism (14%, 14%, 15%). Outcomes across the 3 groups were as follows: 

First NIHSS (median =0); discharge NIHSS (median = 0,3,2), with tenecteplase group having the lowest median discharge score. Mortality in the tenecteplase group and no thrombolytic groups was 2%, compared to 3% in the alteplase group.  Median hospital length of stay was 3 days for both the tenecteplase and alteplase groups, compared to 2 days for the no thrombolytic group.  

In cohorts matched for baseline demographics and co-morbidities, tenecteplase performs just as well as alteplase in a real-world community hospital setting and is not associated with any increased risk of adverse events.