Tenecteplase for thrombolysis in stroke leads to better outcomes than alteplase

Most hospitals have a policy on thrombolysis, all using some form of tPA. A lot of them have been thought to be equivalent however – until this Australian trial in the NEJM, comparing tenecteplase and alteplase.

Looking at 75 patients in a phase 2B trial (here’s a reminder of the phases), they gave either alteplase or tenecteplase less than 6 hours (on average around 3 hours) after the ischaemic stroke.

Furthermore to your average protocol, they carefully selected patients who would benefit, by looking for a perfusion lesion 20% greater than the infarct core, using CT perfusion scanning.

The outcomes were measured in a few different ways:

  • improvement in NIHSS score at 24 hours
    • tenecteplase 8, alteplase 3 (however it was 3+/- 6.3)
  • proportion perfused on imaging (MRI based)
    • tenecteplase 79%, alteplase 55% (p=0.004)
  • absence of disability at 90 days
    • tenecteplase 72%, alteplase 40% (p=0.02)
  • ‘excellent’ recovery at 90 days
    • tenecteplase 27, alteplase 10, but a non-significant p value at 0.25
    • note that the ‘excellent or good recovery at 90 days’ had a more significant p value of 0.02

Overall, bleeding outcomes were similar between the two groups (small numbers however), and mortality was similar.

Interesting study and a suprisingly marked difference for two drugs of the same class. It is important to note the authors affiliations with various drug companies however, and a larger phase III randomised controlled trial will be more definitive.

Have a read over here.


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