Short-Term Safety and Effectiveness for Tenecteplase and Alteplase in Acute Ischemic Stroke

作者：Justin F. Rousseau, Jeremy M. Weber, Brooke Alhanti, Jeffrey L. Saver, Steven R. Messé, Lee H. Schwamm, Gregg C. Fonarow, Kevin N. Sheth, Eric E. Smith, Michael T. Mullen, Gisele Sampaio Silva, Brian Mac Grory, Ying Xian, Steven Warach · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.0548 · 被引用次数：14 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Stroke Rehabilitation and Recovery

Importance: Tenecteplase is an alternative to alteplase for emergency treatment of acute ischemic stroke. However, limited data are available comparing their clinical effectiveness in routine clinical practice. Objective: To compare short-term effectiveness and safety outcomes for patients with ischemic stroke treated with intravenous tenecteplase vs alteplase. Design, Setting, and Participants: This comparative effectiveness study used data prospectively collected from July 1, 2020, through June 30, 2022, from the Get With The Guidelines-Stroke registry. Exposure: Consecutive patients with ischemic stroke treated with either tenecteplase or alteplase within 4.5 hours from last known well time were included. Main Outcomes and Measures: The primary end point was functional independence on discharge (modified Rankin Scale [mRS] score, 0-2). Secondary effectiveness end points included disability free at discharge (mRS score, 0-1), discharge home, and independent ambulation at discharge. Safety end points included symptomatic intracranial hemorrhage (sICH) within 36 hours and combined in-hospital mortality or hospice discharge. Generalized linear mixed models were fit to evaluate associations between exposure to tenecteplase (vs alteplase) and end points after adjustment for demographic, clinical, and hospital-level variables. Adjusted odds ratios (AORs) with 95% CIs were computed. Results: Among 79 550 patients treated with intravenous thrombolysis, the mean (SD) age was 68.6 (1...