Safety And Tolerability Of Tenecteplase In The Management Of Acute Ischemic Stroke: A Single-Center Observational Study

Background: Tenecteplase is emerging as an alternative thrombolytic agent for acute ischemic stroke, but real-world safety data remains limited. Objective: To evaluate the safety, tolerability, and efficacy of intravenous tenecteplase in acute ischemic stroke patients in a real-world setting. Methods: This prospective observational study included 50 acute ischemic stroke patients treated with intravenous tenecteplase (0.25 mg/kg) at a tertiary care center over six months. Primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 24-36 hours. Secondary outcomes included early neurological improvement and 90-day functional outcomes. Results: The mean age was 68.4 ± 12.3 years, with median baseline NIHSS of 14 (IQR: 8-18). Symptomatic ICH occurred in 3 patients (6.0%, 95% CI: 1.3-16.5%). Early neurological improvement was observed in 44.0% of patients (p<0.001), and 54.0% achieved favorable functional outcomes (mRS 0-2) at 90 days. Independent predictors of sICH included age >75 years (adjusted OR: 2.4, p=0.014), baseline NIHSS >15 (adjusted OR: 2.8, p=0.004), and ASPECTS score <7 (adjusted OR: 3.1, p=0.002). Time-to-treatment analysis showed better outcomes in patients treated within 120 minutes (66.7% favorable outcomes, p=0.032). Conclusion: Tenecteplase demonstrates an acceptable safety profile and effective outcomes in real-world clinical practice, with identified predictors of hemorrhagic complications guiding patient selection