Intravenous Thrombolysis with Tenecteplase for the Treatment of Acute Ischemic Stroke

Georgios Tsivgoulis* (Corresponding Author), Aristeidis H Katsanos, Christos Christogiannis, Belahsen Faouzi, Dimitris Mavridis, Anand K Dixit, Lina Palaiodimou, Dheeraj Khurana, Marco Petruzzellis, Klearchos Psychogios, Mary Joan Macleod, Niaz Ahmed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


OBJECTIVE: Intravenous thrombolysis (IVT) with tenecteplase has been associated with better clinical outcomes in acute ischemic stroke (AIS) patients with confirmed large vessel occlusions compared to IVT with alteplase. However, the utility of tenecteplase for the treatment of all AIS patients eligible for IVT has not been established.

METHODS: We compared the safety and efficacy of tenecteplase versus alteplase in AIS patients by analyzing propensity score matched data from 20 centers participating in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register. Patients receiving IVT with tenecteplase were matched with up to 3 patients receiving alteplase from the same center. The primary outcome of interest was the distribution of 3-month functional outcomes. Secondary outcomes included the rates of patients with symptomatic intracranial hemorrhage (SICH) in the first 24 hours, excellent (modified Rankin Scale [mRS] score = 0-1) or good (mRS score = 0-2) functional outcome, and all-cause mortality at 3 months.

RESULTS: A total of 331 tenecteplase-treated AIS patients were matched to 797 patients treated with alteplase (median age = 70 years, 43.9% women, median National Institutes of Health Stroke Scale score = 11, interquartile range = 6-17). Patients treated with tenecteplase had better 3-month functional outcomes (common odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.18-2.00) with higher odds of good functional outcome (OR = 2.00, 95% CI = 1.45-2.77) and a lower likelihood of all-cause mortality (OR = 0.43, 95% CI = 0.27-0.67) at 3 months, compared to alteplase-treated patients. No difference was found in the likelihood of the 3-month excellent functional outcomes (OR = 1.31, 95% CI = 0.96-1.78) and 24-hour SICH (1.0% vs 1.3%, OR = 0.72, 95% CI = 0.20-2.64).

INTERPRETATION: IVT with tenecteplase was associated with better 3-month clinical outcomes compared to IVT with alteplase in AIS patients, with no increased risk of symptomatic intracranial bleeding. ANN NEUROL 2022.

Original languageEnglish
Pages (from-to)349-357
Number of pages9
JournalAnnals of Neurology
Issue number3
Early online date7 Jul 2022
Publication statusPublished - Sept 2022

Bibliographical note

We thank all SITS-ISTR investigators and their centers for participating. We also thank all the patients who participated in SITS-ISTR. The current SITS-ISTR is developed, maintained, and upgraded by Zitelab (Copenhagen, Denmark) in close collaboration with SITS. SITS is financed directly and indirectly by grants from the Karolinska Institute, Stockholm County Council, and Swedish Heart-Lung Foundation. SITS has previously received grants from the European Union Framework 7 and the European Union Public Health Authority. N.A. is supported by grants provided by the Stockholm County Council and Swedish Heart-Lung Foundation. No funding sources played a part in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. A.H.K. holds a McMaster University Department of Medicine Career Research Award.


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