Tenecteplase versus alteplase: impact of time to thrombolysis on clinical outcomes

AcT (NCT03889249) was a Phase III, pragmatic, randomized trial comparing the use of intravenous tenecteplase with alteplase for acute ischemic stroke reperfusion. Findings from over 1500 patients showed that tenecteplase was non-inferior to alteplase in treating acute ischemic stroke within 4.5 hours of symptom onset. Nishita Singh, MD, University of Calgary, Calgary, Alberta, Canada, discusses an analysis the impact of time to IVT on clinical trial outcomes with tenecteplase versus alteplase in the AcT trial. The impact of both onset to needle time (ONT) and door to needle time (DNT) on functional outcome was assessed. The type of intravenous thrombolytic was shown to have no significant impact on the relationship between ONT and odds of achieving modified Rankin scale 0-1(mRS) at 90 days. When assessing only patients treated in the 3-4.5-hour time window, tenecteplase performed slightly better than alteplase but the findings were non-significant. For DNT, tenecteplase achieved better results than alteplase throughout the 4.5-hour time window, but again, these findings were non-significant. Overall, this study highlights that faster treatment leads to better clinical outcomes when using tenecteplase, just as with alteplase, and that tenecteplase may improve mRS 0-1 rates in the later time window. This interview took place at the World Stroke Congress 2022 in Singapore.

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