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Tenecteplase Appears Superior to Alteplase After Ischemic Stroke

Tenecteplase within 4.5 hours after symptoms linked to higher reperfusion, better functional outcomes

THURSDAY, April 26, 2018 (HealthDay News) — For patients with ischemic stroke, treatment with tenecteplase within 4.5 hours of symptom onset and before thrombectomy is associated with better outcomes than treatment with alteplase during the same timeframe, according to a study published in the April 26 issue the New England Journal of Medicine.

Bruce C.V. Campbell, Ph.D., from the Melbourne Brain Centre in Australia, and colleagues randomized 202 patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery, and who were eligible for thrombectomy, to receive tenecteplase (101 patients) or alteplase (101 patients) within 4.5 hours after symptom onset. Primary outcome was reperfusion of greater than 50 percent of the involved ischemic territory or an absence of retrievable thrombus at the time of the initial angiographic assessment.

The researchers found that the primary outcome occurred in 22 and 10 percent of those treated with tenecteplase and alteplase, respectively (incidence ratio, 2.2; 95 percent confidence interval, 1.1 to 4.4; P = 0.002 for non-inferiority; P = 0.03 for superiority). Better 90-day functional outcome was seen with tenecteplase versus alteplase (median modified Rankin scale score, 2 versus 3; common odds ratio, 1.7; 95 percent confidence interval, 1.0 to 2.8; P = 0.04). In each group, 1 percent of patients experienced symptomatic intracerebral hemorrhage.

“Tenecteplase before thrombectomy was associated with a higher incidence of reperfusion and better functional outcome than alteplase among patients with ischemic stroke treated within 4.5 hours after symptom onset,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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