Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke

BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of mortality and disability. Patients who receive thrombolytic therapy promptly tend to have better outcomes. Although alteplase (tPA) is the standard Food and Drug Administration-approved thrombolytic for AIS treatment, recent American Heart Association guidelines suggest that tenecteplase (TNK) can be used as an alternative. This project compares the cost-effectiveness and clinical outcomes of TNK versus tPA in AIS treatment. Key outcomes include door-to-needle time, length of stay, National Institutes of Health Stroke Scale scores, and the incidence of hemorrhagic conversion events. METHODS: The project involved retrospective analysis through medical chart reviews at a thrombectomy-capable stroke center in a Pacific Northwest community hospital. Data were collected from 175 AIS patients treated with either tPA (82) or TNK (93) between March 2022 and December 2023. Patients eligible for thrombolytic therapy received tPA before March 15, 2023, with TNK used thereafter. Selection criteria adhered to American Heart Association guidelines and clinicians' judgment. RESULTS: Although door-to-needle times were similar ( P = .20), excluding outliers revealed a significant difference favoring TNK ( P = .04). No significant group differences were observed for demographics, National Institutes of Health Stroke Scale scores, length of stay, or post-intracerebral hemorrhage rates. Tenecteplase use resulted in over $40 000 in medication savings during the project period. CONCLUSION: Tenecteplase offers comparable safety and efficacy to tPA for treating AIS, with the added benefit of cost savings. Although clinical outcomes did not significantly differ between the 2 drugs, TNK's reduced cost and ease of administration make it an attractive option, particularly in resource-limited settings. These results support the current organizational treatment protocol favoring TNK.