(720) Efficacy and Safety of Tenecteplase vs Alteplase for Treatment of Ischemic Stroke in Puerto Rico

Introduction: Tenecteplase has been demonstrated to be non-inferior to alteplase for the acute management of ischemic stroke in various countries. Despite this, clinical guidelines still limit its use and recommend alteplase as the standard treatment. This study aims to answer the question of the difference in efficacy and safety between tenecteplase and alteplase for the acute management of ischemic stroke in one stroke center in Puerto Rico.

Methods: This single-center, retrospective cohort study used the electronic medical record system to identify adult patients who completed their treatment of tenecteplase or alteplase for acute ischemic stroke in 2023. The study's primary outcome was the proportion of participants with an excellent modified Rankin Scale (mRS) score of 0-1 at 90 days. Secondary outcomes included the proportion of participants with a good mRS score of 0-2 at 90 days, major neurological improvement, ease of administration, and total hospitalization costs. Safety outcomes included symptomatic and asymptomatic intracranial hemorrhage and adverse events related to angioedema.

Results: There were 52 patients treated with tenecteplase and 60 with alteplase. The majority of patients were females (55%) with a mean age of 74 and with moderate stroke on admission. The primary outcome was achieved in the alteplase group at 45.0% vs. 23.1% in the tenecteplase group (OR 0.367; p=0.015). The secondary outcome of the proportion of participants with a good mRS score of 0-2 was achieved in the alteplase group with 53.3% vs. 30.8% in the tenecteplase group (OR 0.389; p=0.016). Ease of administration results showed tenecteplase group at 51.46 minutes vs. 60.70 minutes in the alteplase group (p=0.015). All other outcomes demonstrated non-statistically significant associations between groups.

Conclusions: Our study found that the use of tenecteplase had a statistically significant unfavorable association in the proportion of participants who had an excellent mRS score of 0-1 and a good mRS score of 0-2 at 90 days. Other outcomes showed that tenecteplase had a statistically significant favorable association in ease of administration and comparable major neurological improvement at 24 hours, hospitalization costs, and safety outcomes to alteplase.