Trends and outcomes of tenecteplase and alteplase usage for ischemic stroke in the United States

Background

Tenecteplase (TNK) has recently become a compelling alternative to alteplase. This study aims to compare the usage trends and outcomes of TNK versus alteplase in acute ischemic stroke.

Methods

We conducted retrospective analysis using the Cosmos Epic database to include ischemic stroke patients treated with intravenous thrombolysis between 1 and 1–2016 and 12–31–2023. The primary outcomes were 1) trend in the usage of alteplase vs. TNK and 2) home discharge. Secondary outcomes included 90-day mortality, in-hospital mortality, and rates of intracranial hemorrhage.

Results

The study included 71,150 patients (mean age, 67.46 years; 50.2 % male; mean NIH Stroke Scale score, 4.34; 73 % White). A total of 52591 patients (73 %) were treated with alteplase. Over the study period, the use of alteplase decreased, whereas TNK usage increased, surpassing alteplase by mid-2022. The rate of home discharge was higher in the TNK group (59.3 % vs. 58 %; P = .002), and TNK was associated with home discharge (odds ratio [OR], 1.17; 95 % CI, 1.12–1.22). There was no significant association between TNK and 90-day mortality. Intracranial hemorrhage was more common in the TNK group. In a sensitivity analysis restricted to patients who received endovascular therapy, TNK was associated with higher odds of home discharge, lower odds of in-hospital mortality, and higher odds of intracranial hemorrhage.

Conclusion

Since 2022, the utilization of TNK for acute ischemic stroke in the US has increased significantly. TNK was associated with a higher likelihood of home discharge compared to alteplase. These findings support the use of TNK in clinical practice.