Abstract TP011: Outcomes of acute ischemic stroke patients receiving IV tenecteplase versus IV alteplase with and without thrombectomy in real world setting

We compared the real-world safety and efficacy outcomes of intravenous tenecteplase (TNK) and intravenous alteplase (tPA) in acute ischemic stroke (AIS) patients eligible for mechanical thrombectomy (MT) from 10/2020 to 03/2023. We examined the data of 270 AIS patients who received IV thrombolysis, either TNK or tPA. Safety parameters include new subarachnoid hemorrhage, intracerebral hemorrhage, intracranial hemorrhage, and non-routine discharge. The primary efficacy outcome was defined as a major neurological improvement, indicated by an improvement in the NIHSS score scale by 8 or more points. Data was further stratified if the patients received mechanical thrombectomy (MT) or not. 150 patients received IV tPA while 120 received IV TNK. There was higher incidence of new intracranial hemorrhage (44.2% vs. 20%, p=0.015)&symptomatic intracerebral hemorrhage (16.3% vs. 4.4%, p=0.067) in patients receiving TNK and undergoing MT compared to IV tPA and MT. Major neurological improvement was more prevalent in non-thrombectomy groups for both thrombolytics. Multivariate analysis revealed that TNK and thrombectomy were associated with a significantly higher risk of any intracranial hemorrhage (adjusted odds ratio [aOR] 3.69, CI 1.22-11.15, p=0.020). Non-routine discharges were also more frequent in TNK-treated patients (aOR 7.24, CI 2.07-25.51, p=0.002). The likelihood of major neurological improvement at 24 hours showed a marginal association with TNK and thrombectomy treatment (aOR 1.96, CI 0.615-6.245, p=0.255). In conclusion, this single center, real-world study, provides compelling evidence that IV TNK is associated with a higher incidence of intracranial hemorrhage when compared to IV tPA in AIS patients who underwent MT.