Efficacy and safety of tenecteplase versus alteplase in acute ischemic stroke: Evidence from a South Indian cohort

Background. Acute ischemic stroke (AIS) requires efficient thrombolytic therapy to re-establish vascular permeability and mitigate tissue damage. Alteplase and tenecteplase are prominent tissue plasminogen activators (tPAs) employed in this clinical scenario. This study compares these two agents, focusing on their efficacy, safety profiles, time parameters, and rates of re-hospitalization. Objectives. To compare the efficacy and safety of tenecteplase versus alteplase for treating acute ischemic stroke in South Indian patients: a prospective study. Methods. At a single center, we conducted a prospective, observational, non-interventional study of patients receiving thrombolytics alteplase or tenecteplase from November 2023 to July 2024, which included patients within a 4.5-hour window of symptom onset. The principal outcome of this study is to evaluate early neurological improvement using the clinical assessment scales – the National Institutes of Health Stroke Scale (NIHSS) at baseline and 24 hours, and the Modified Rankin Scale (mRS) at admission and 3 months. The secondary outcomes include the door-to-needle time (DTN) and assessing the need for re-hospitalization. Data was scrutinized using a t-test and median interquartile range (IQR). Results. The study enrolled 64 patients, 32 treated with alteplase and 32 with tenecteplase. Statistical significance was found for the efficacy of the drugs (NIHSS post-treatment p = 0.01 and mRS p = 0.002). The DTN and re-hospitalization were found to be non-significant. Conclusion. Both alteplase and tenecteplase efficiently manage AIS, with tenecteplase demonstrating advantages in early neurological improvement, ease of administration, and cost-effectiveness.