The following is a summary of “Functional Outcome and Hemorrhage Rates After Bridging Therapy With Tenecteplase or Alteplase in Patients With Large Ischemic Core,” published in the June 2024 issue of Neurology by Gerschenfeld et al.
Researchers conducted a retrospective study comparing the effectiveness and safety of tenecteplase versus alteplase before mechanical thrombectomy (MT) in patients with large-vessel occlusion (LVO) and large ischemic core.
They involved patients with anterior circulation LVO strokes and DWI-ASPECTS ≤5 treated with tenecteplase or alteplase before MT from the TETRIS (tenecteplase) and ETIS (alteplase) French multicenter registries. The primary outcome assessed was improved disability at 3 months using ordinal analysis of the mRS. Safety endpoints included 3-month mortality, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage (sICH). Propensity score overlap weighting was employed to minimize baseline differences between treatment groups.
The results showed 647 patients (tenecteplase: n = 194, alteplase: n = 453, inclusion period 2015–2022). Median IQR age was 71 (57–81) years, with NIH Stroke Scale score 19 (16–22), DWI-ASPECTS 4 (3–5), and last seen well-to-IV thrombolysis and puncture times 165 minutes (130–226) and 260 minutes (203–349), respectively. Post-MT, the successful reperfusion rate was 83.1%. Following propensity score overlap weighting, baseline variables balanced well between treatment groups. Compared with alteplase, tenecteplase-treated patients had better 3-month mRS (standard OR for reduced disability: 1.37, 1.01–1.87, P=0.046) and lower 3-month mortality (OR 0.52, 0.33–0.81, P<0.01). No significant differences in PH (OR 0.84, 0.55–1.30, P=0.44) and sICH incidence (OR 0.70, 0.42–1.18, P=0.18) between thrombolytics.
Investigators concluded that tenecteplase showed promise as a safe and effective bridging therapy for patients with LVO ischemic stroke with large ischemic cores, compared to alteplase, warranting its consideration as an alternative in clinical practice.
Source: neurology.org/doi/10.1212/WNL.0000000000209398
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