Treatment of ischaemic stroke with tenecteplase is associated with a lower odds of symptomatic intracranial haemorrhage (sICH) than treatment with alteplase.

The retrospective CERTAIN study of 9,238 patients from more than 100 hospitals across Australia, New Zealand and the US, found treatment with 0.25-mg/kg tenecteplase effectively halved the risk of sICH compared to treatment with 0.9-mg/kg alteplase (1.8% v 3.6%; OR 0.49).

Patients treated with tenecteplase were older (73 vs 70 years; P <0.001), more often male (54% v 51%; P =0.007), had higher baseline NIHSS scores (median 9 v 7; P <0.001), and had longer symptom-to-needle time (141 v 136 minutes; P = 0.002).

Tenecteplase was also associated with a shorter door-to-needle time (49 vs 53 minutes; P < 0.001). Tenecteplase patients were likely to have large vessel occlusion (48% v 25%; P < 0.001) and more frequently underwent mechanical thrombectomy after thrombolysis (38% v 20%]; P <0.001).

However the study, published in JAMA Neurology [link here], found the risk of sICH was similar in the subgroups of patients with and without subsequent thrombectomy.

“Absolute mortality rates were higher in the unadjusted tenecteplase group; however, this difference was not observed in the adjusted models,” the study said.

Patients treated with tenecteplase were more likely to have an mRS score 0 to 1 at 90 days than those treated with alteplase (OR, 1.57; 95% CI, 1.16-2.12; P = 0.003), but not an mRS score 0 to 2 (OR, 1.44; 95% CI, 1.00-2.09; P = 0.05)

“Our results support the safety of tenecteplase stroke thrombolysis,” the investigators said.

They said the study is the largest published cohort of stroke patients treated with tenecteplase in clinical practice.

Its results are consistent with current best practice guidelines from the American Heart Association/American Stroke Association, the European Stroke Organisation, and the Australian and New Zealand Living Stroke Guidelines which have all made limited recommendations for tenecteplase as an alternative thrombolytic option for patients with stroke.