Safety and Efficacy Outcomes of Off-Label Tenecteplase versus Alteplase for Acute Ischemic Stroke: Real-World Experience

Background: Tenecteplase offers several practical advantages over alteplase; recent comparative studies have demonstrated tenecteplase to be non-inferior to alteplase in terms of its safety and efficacy in acute ischemic stroke (AIS). We recently switched to Tenecteplase for AIS from alteplase and describe our real-world outcome data. Objectives: To compare the efficacy and safety of alteplase with tenecteplase for AIS. Methods: We conducted a retrospective study of patients’ thrombolysis with alteplase or Tenecteplase from January 1 st , 2021, to December 31 st , 2021. Patients were included if they had received alteplase or tenecteplase within 4.5 hours of symptom onset. Patients with wake-up stroke were excluded. The primary outcome was a composite of bleeding-related adverse events. Secondary outcomes included door-to-needle (DTN) time, median 24-hour National Institute of Health Stroke Scale (NIHSS) score, discharge NIHSS score