Abstract WP034: Prehospital Thrombolysis on the Mobile Stroke Unit: A Comparative Analysis of Tenecteplase vs Alteplase

Background: Tenecteplase (TNK) has increasingly replaced alteplase (tPA) as the intravenous thrombolytic (IVT) of choice in acute ischemic stroke due to its longer half-life, greater fibrin specificity and single-bolus administration. We compared TNK and tPA administration in the prehospital setting using mobile stroke units (MSU). Objective: To compare TNK and tPA on MSU door to IVT and alarm to IVT times in the MSU setting and the rates of functional stroke outcomes. Methods: We conducted a single-center, retrospective review of patients treated with IVT on the MSU, comparing those who received tPA (2018-2022) with those who received TNK (2022-2025). Outcomes included MSU door-to-IVT and alarm-to-IVT times, acute hospital discharge destination, hospital discharge NIHSS and mRS, and follow-up mRS (30- and 90-day). Unadjusted comparisons were performed using the Wilcoxon rank-sum test. Generalized linear regression models were applied to evaluate IVT timing metrics, adjusting for confounders. Results: A total of 130 patients were included; 65 received TNK and 65 tPA. There were no significant differences in the MSU door-to-IVT (median 21 vs 19 min) and alarm-to-IVT (median 42 vs 39 min) times between the two groups. Outcomes were similar between TNK and tPA across discharge NIHSS (median 2 (interquartile range (IQR) 0-4) vs 2.5 (IQR0-8)), discharge mRS (median 2 (IQR 1-3) vs 3.00 (IQR 1-4)) vs 2.5 (IQR 0-4)). However, a significant difference was observed in 30-day mRS (median 2 (IQR 1- 4) vs 0 (IQR 0-2)). There was no significant difference in the rates of radiographic parenchymal hemorrhage (PH1 and PH2) on the 24 hour repeat CT Head between TNK (6.9%) and tPA (6.2%) groups. Discussion: In this single-center MSU cohort, TNK and tPA demonstrated comparable treatment times and functional outcomes in the prehospital setting. While TNK offers logistic advantages in administration, our findings suggest no meaningful differences in time-to-treatment or most clinical outcomes.