2025 Southeastern Residency Conference

Title: Comparison of Alteplase versus Tenecteplase for Treatment of Acute Ischemic Stroke at a Large Community Hospital


Authors: Abigail Edwards, Rachel Settle, Anne Astin, Anna-Kathryn Priest


Background: Although tenecteplase lacks FDA approval for acute ischemic stroke, the evidence available suggests tenecteplase is non-inferior to alteplase and potentially more efficacious in patients with large vessel occlusion strokes. The 2019 American Heart Association/American Stroke Association and 2023 European Stroke Organization Recommendations currently state that tenecteplase is a reasonable alternative over alteplase for use in acute ischemic stroke. In November 2023, the Baptist Health System transitioned to tenecteplase from alteplase for eligible patients with acute ischemic stroke. The purpose of this study is to compare the efficacy and safety of alteplase versus tenecteplase for acute ischemic stroke in the Baptist Health System.
 
Methods: This is an institutional review committee approved retrospective, single-center observational cohort study using electronic health records of adult patients 19 years of age or older within the Baptist Health System before and after the transition to tenecteplase for acute ischemic stroke. Patients were included if they had a documented NIHSS score and received either tenecteplase or alteplase for acute ischemic stroke. Data on tenecteplase was collected between November 2023 and June 2024, and an equal number of patients who received alteplase was collected in the months prior to the system-wide change.
 
Results: Of the 136 electronic medical records reviewed, 94 met inclusion criteria. The average change in NIHSS score was -4.5 in the tenecteplase group versus -3.9 in the alteplase group. There was a total of 5 bleeding events in the tenecteplase group versus 10 in the alteplase group. When comparing clinically significant bleeds ( ≥ 4 increase in NIHSS), tenecteplase had 1 while alteplase had 2 bleeding events that met criteria. Neither the tenecteplase or alteplase group had a documented angioedema event.
 
Conclusion: Our study found that tenecteplase had a similar efficacy compared to alteplase when used for acute ischemic stroke in the Baptist Health System. Tenecteplase also had a comparable, if not slightly better, safety profile.