Authors (including presenting author) :
Wan KS, Lui HT, Lo YT, Chung CF
Affiliation :
Department of Medicine, Tseung Kwan O Hospital
Keyword 1: :
Acute ischemic stroke
Keyword 2: :
Thrombolysis
Keyword 3: :
Tenecteplase
Introduction :
According to the AHA/ASA guidelines in 2019, the use of Alteplase for intravenous thrombolysis in suitable patients with acute ischemic stroke is considered the standard treatment. Recent clinical trials have demonstrated that the efficacy of Tenecteplase is non-inferior to that of Alteplase. Therefore, starting in May 2024, Tenecteplase has become the first choice for thrombolysis in TKOH.
Objectives :
1. To enhance treatment options in line with international trends and developments 2. To evaluate the efficacy of Tenecteplase compared to Alteplase
Methodology :
Recent evidence, including the AcT , ORIGINAL and Attest-2 trials, has demonstrated the non-inferiority of Tenecteplase to Alteplase. We transitioned to using Tenecteplase as the first-choice thrombolytic agent for suitable acute ischemic stroke patients from May 6, 2024. We conducted a retrospective review and compared clinical and safety outcomes, including: 1) modified Rankin Scale (mRs) score at 90 days, 2) rate of symptomatic intracranial hemorrhage(ICH), and 3) rate of all-cause mortality within 90 days between patients treated with Alteplase and those treated with Tenecteplase. The review period for the Alteplase group was May 2023 to April 2024, while for the Tenecteplase group, it was May 2024 to April 2025. The data were retrieved from CDARS and the TKOH stroke team data bank for analysis. The statistical program Jamovi was used for statistical analysis.
Result & Outcome :
From May 2023 to April 2024, 73 acute ischemic stroke patients received Alteplase, whereas during the period from May 2024 to April 2025, 85 patients received Tenecteplase. Mann- Whitney U test and Chi- Square test were employed to compare the baseline characteristics including Age, Sex, NIHSS score before treatment, underlying Atrial Fibrillation (AF), hypertension, hyperlipidemia, Diabetes Mellitus and smoking history between groups. The age between the two groups showed a statistically significant difference, with p = 0.023 in the Mann-Whitney U test, indicating that the median age of the Tenecteplase group (75 years) was significantly higher than that of the Alteplase group (70 years). The proportion of patients with AF between the two groups also showed a statistically significant difference, with p = 0.022 in the Chi-Square test, indicating that there were more patients with AF in the Tenecteplase group (Tenecteplase group: 30.6%, Alteplase: 15.1%). For other baseline characteristics, no statistically significant differences were detected, with p values greater than 0.05 (Median NIHSS: p = 0.414; Sex: p = 0.632; Hypertension: p = 0.145; Hyperlipidemia: p = 0.305; Diabetes Mellitus: p = 0.539; Smoking: p = 0.404). Regarding clinical and safety outcomes, 61.6% (n = 45) of patients in the Alteplase group achieved a mRS score of 0-1 at 90 days. Additionally, 8.2% (n = 6) of these patients experienced symptomatic ICH following thrombolysis, and 6.8% (n = 5) died within 90 days. In the Tenecteplase group, 61.2% (n = 52) achieved a mRS score of 0-1 at 90 days. Furthermore, 5.9% (n = 5) of patients experienced symptomatic ICH after thrombolysis, and 9.4% (n = 8) died at 90 days. The proportions of patients achieving a mRS score of 0-1 at 90 days, symptomatic ICH, and all-cause mortality within 90 days between the Alteplase and Tenecteplase groups were compared using the Chi-Square test. All differences in treatment response, safety outcomes, and mortality between the two groups were statistically insignificant, with p values greater than 0.05, despite the median age of the Tenecteplase group appearing higher and more patients having AF (mRS score 0-1 at 90 days: p = 0.952; symptomatic ICH: p = 0.565; all-cause mortality within 90 days: p = 0.559) This retrospective review supports the current evidence of the non-inferiority of Tenecteplase compared to Alteplase, as there were no statistically significant differences in clinical and safety outcomes between the Alteplase and Tenecteplase groups.
