Tenecteplase may improve stroke outcomes in patients with salvageable brain tissue

In patients with non–large vessel occlusion acute ischemic stroke and salvageable brain tissue, administering intravenous tenecteplase between 4.5 and 24 h after stroke onset helps increase the chances of having an excellent functional outcome, although it contributes to an increased risk of symptomatic intracranial haemorrhage, according to a study.

The study included 566 patients (median age 68 years, 34.6 percent female) with non–large vessel occlusion stroke and evidence of potentially salvageable tissue, which was ascertained using perfusion imaging. These patients presented within 4.5 to 24 hours of the time last seen well.

The patients were randomly assigned to receive intravenous tenecteplase (0.25 mg/kg; maximum dose 25 mg; n=282) or standard medical treatment (n=284). An excellent functional outcome, defined as a score of 0 or 1 on the modified Rankin Scale at 90 days, was the efficacy outcome. Safety outcomes included symptomatic intracranial haemorrhage within 36 hours and mortality within 90 days.

At 90 days, 43.6 percent of patients in the tenecteplase group achieved an excellent functional outcome compared with 34.2 percent in the control group (risk ratio, 1.28, 95 percent confidence interval [CI], 1.04–1.57; p=0.02).

However, symptomatic intracranial haemorrhage occurred more frequently among patients in the tenecteplase vs the control group (2.8 percent vs 0 percent; risk difference, 2.85 percent, 95 percent CI, 1.16–5.54; p=0.004). There was no significant between-group difference in the 90-day mortality rate (5 percent vs 3.2 percent, respectively; risk ratio, 1.57, 95 percent CI, 0.69–3.57; p=0.28).