A Study of Tenecteplase in Acute Ischaemic Stroke: A Descriptive Real World Single Centre Experience from a Public Tertiary Care Hospital in Western India

Background This study evaluates the efficacy and safety of tenecteplase, a newer thrombolytic agent, in acute ischaemic stroke (AIS) at a tertiary public care centre in Western India. Methods This retrospective study analysed 30 patients with AIS treated with tenecteplase, presenting within 4.5 hours from onset and receiving 0.25 mg/kg of tenecteplase. Primary outcomes were patients achieving a modified Rankin Scale (mRS) score of 0-1 at 90 days and those showing an improvement of the National Institutes of Health Stroke Scale (NIHSS) by 4 after 24 hours of thrombolysis. The secondary outcome was patients showing an improvement of NIHSS by 2 after 24 hours of thrombolysis and the number of patients showing an mRS score of 0-2 at 90 days. Safety outcomes were symptomatic intracerebral haemorrhage (ICH), all intracranial bleeding occurring within 24 hours, and in-hospital mortality. The impact of age and sex on outcomes was assessed. Results The mean age was 55.86 years. The mean symptom onset-to-hospital arrival time was 111.4 minutes and the mean door-to-needle time was 64.66 minutes. Out of all patients, 22 were male, and 8 were female. The mean NIHSS was 11.86 at presentation and 7.97 at 24 hours. The primary outcome of mRS 0-1 at 3 months was achieved in 19 patients; change in NIHSS ≥4 at 24 hours was in 7 patients. For secondary outcome, NIHSS change of 2 at 24 hours occurred in 13 patients, while 25 patients achieved mRS 0-2 at 3 months. Symptomatic ICH occurred in 1 patient, any ICH occurred in 7, while 2 patients had in-hospital mortality. Conclusion Tenecteplase is a safe and effective option for patients with AIS presenting within 4.5 hours.