Effectiveness and Safety of Tecneplase vs. Alteplase in the Acute Treatment of Ischemic Stroke

Abstract

Not all hospitals have interventional radiology services. This fact implies that in centers where this resource is not available, the treatment of stroke in the acute phase must be adapted and individualized. The aim of the study is to determine and compare the combined effect of thrombolysis and thrombectomy effectiveness and safety of tenecteplase versus alteplase in the acute treatment of ischemic stroke in patients who are candidates for endovascular therapy according to clinical practice guidelines. This paper details a retrospective multicenter cohort study of patients with ischemic stroke admitted in three hospitals between 2018 and 2020. The main outcome variables were the degree of recanalization and the functional outcome at 3 months; safety variables were mortality and the occurrence of intracranial hemorrhage (ICH). In total, 100 patients were included, 20 of which were treated with tenecteplase (TNK) and 80 with alteplase (rtPA). Of those treated with TNK, 75% obtained a successful recanalization compared to 83.8% in those treated with rtPA (OR 0.58; 95% CI 0.18–1.88; p = 0.56). No differences were found in obtaining an excellent functional result at 3 months (35% TNK vs. 58.8% rtPA; p = 0.38). Tenecteplase showed worse neurological results after 24 h (unfavorable result of 70% with TNK vs. 45% with rtPA; OR = 5.4; 95% CI 1.57–18.6). No significant differences were identified in mortality; 17.5% with rtPA and 20% with TNK (p = 0.79), nor in the appearance of intracranial hemorrhage ICH (15.2% with rtPA vs. 30% with TNK (p = 0.12). In our series, there were not significant differences shown regarding effectiveness and safety between tenecteplase and alteplase.

Comprehensive Review of Tenecteplase for Thrombolysis in Acute Ischemic Stroke

“…The rates of sICH between the 2 groups had no significant difference. 72 Estella et al 73 conducted a multicenter, retrospective, observational cohort study to compare intravenous tenecteplase (0.25 mg/kg) versus alteplase (0.9 mg/kg) in the bridging therapy for patients diagnosed with AIS due to LVO. One hundred patients (tenecteplase= 0, alteplase=80) who underwent fibrinolysis at the primary stroke center and then transferred to a comprehensive stroke center for thrombectomy were included.…”