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ISC 2023 | Tenecteplase versus alteplase in a real-world setting

Adnan Qureshi, MD, University of Missouri-Columbia, Columbia, MO, shares the findings of a real-world data study assessing outcomes after intravenous thrombolysis for acute ischemic stroke with alteplase versus tenecteplase. Tenecteplase is becoming increasingly used as the prefered thrombolytic given its ease of use, with comparative trials showing it to be at least as effective as alteplase. As with all controlled trials, rigorous patient selection can make the treatment population different to what is seen in clinical practice. For this reason, Dr Qureshi assessed the real-world use of tenecteplase, analyzing outcome data from 122 healthcare facilities. More than 30,000 patients were included in the study, of whom ~4% received tenecteplase. Interestingly, the rate of thrombectomy use was significantly higher in the tenecteplase group compared to the alteplase group, suggesting preferential use in more serious cases. There was no difference in the rate of non-routine discharge or death between the two trial arms. Rates of intracranial hemorrhage were higher in those receiving tenecteplase, but it is unclear if this is attributable to the thrombolytic itself, or due to the differing patient characteristics between the two study groups. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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