Tenecteplase matches alteplase for thrombolysis in mild stroke

  • Rønning OM & al.
  • Stroke
  • 3 Jan 2019

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Among patients with predominantly mild stroke, tenecteplase (TNKase) was at least as efficacious and safe as alteplase (Activase, others) when administered within 3-4.5 hours of symptom onset.

Why this matters

Key results

  • Median admission National Institutes of Health Stroke Scale score: 3.
  • Good functional outcome at 3 months in intention-to-treat analysis:
    • 57% with tenecteplase vs 53% with alteplase;
    • OR, 1.19 (95% CI, 0.68-2.10).
  • Findings same after excluding patients with stroke mimics or with modified Rankin scale score >1 before stroke:
    • 61% vs 57%;
    • OR, 1.24 (95% CI, 0.65-2.37).
  • Intracranial hemorrhage in first 48 hours:
    • 5.7% vs 6.7%;
    • OR, 0.84 (95% CI, 0.26-2.70).
  • Mortality at 3 months:
    • 5.7% vs 4.5%;
    • OR, 1.19 (95% CI, 0.35-4.71).

Study design

  • Prespecified substudy of 194 patients from phase 3 randomized controlled trial comparing tenecteplase with alteplase (Norwegian Tenecteplase Stroke Trial, NOR-TEST).
  • Main outcomes: good functional outcome (modified Rankin scale score, 0 or 1), intracranial hemorrhage, mortality.
  • Funding: Research Council of Norway.

Limitations

  • Generalizability to more severe stroke unknown.
  • Rates of intracranial hemorrhage, mortality lower than expected.

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