Comparative effectiveness and safety of tenecteplase versus alteplase for intravenous thrombolysis in acute ischemic stroke: a retrospective study

作者：Weili Zhao, Feng Zhang, Yang Zhao, Ruijie Zhao, Yalin Liu · 发表于：Frontiers in Neurology · 年份：2025 · DOI：10.3389/fneur.2025.1691168 · 被引用次数：1 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、S100 Proteins and Annexins

Background Tenecteplase has been proposed as a practical alternative to alteplase for intravenous thrombolysis in acute ischemic stroke. Although randomised trials have demonstrated noninferiority, data from real-world comparative cohorts remain limited. Aim This study evaluated functional and safety outcomes of tenecteplase compared with alteplase in a single-center cohort. Methods We retrospectively analysed consecutive patients with acute ischemic stroke who underwent intravenous thrombolysis with either tenecteplase or alteplase between April 2023 and April 2025. The primary endpoint was excellent functional recovery at 90 days, defined as a modified Rankin Scale (mRS) score of 0–1. Secondary endpoints included functional independence (mRS 0–2), early neurological improvement, and symptomatic intracranial hemorrhage (sICH). Multivariable logistic regression was used with adjustments for age, baseline NIHSS, diabetes, and atrial fibrillation. Subgroup analyses were performed by age, baseline stroke severity, and history of prior stroke. Results A total of 226 patients were included, of whom 147 received alteplase and 79 received tenecteplase. Patients receiving alteplase were older (68 vs. 65) and more frequently had diabetes (49.0% vs. 34.2%) or atrial fibrillation (18.4% vs. 7.6%). At 90 days, good functional outcome (mRS 0–2) was achieved in 27.9% overall (31.6% tenecteplase vs. 26.0% alteplase) and excellent outcome (mRS 0–1) in 20.4% (22.2% vs. 19.3%). Early neurologi...