Abstract TP012: Incidence of Complications Post Tenecteplace for Ischemic Stroke: Support for Reduced Frequency Monitoring

Patients receiving intravenous thrombolytics are typically admitted to the intensive care unit for frequent monitoring of vital signs and neurological status. Recent studies have built a case for reduced frequency monitoring in patients who are not at high risk for complication following administration of a thrombolytic agent. The current study provides a retrospective review of real-world outcomes of patients who may have been considered for reduced frequency monitoring after receiving Tenecteplase (TNK). A retrospective analysis was completed for individuals receiving TNK for AIS with an National Institute of Heal Stroke Scale (NIHSS) of <10 from July 2022 to June 2025. Patients who underwent thrombectomy or who were in-house for another reason at the time of the stroke were excluded. Additional criteria required for low-frequency monitoring were not applied for the initial review of the data to allow for further evaluation of patient characteristics. NIHSS scores for the first 24 hours were reviewed to identify early neurological deterioration (END), defined as an increase of ≥4 points. Descriptive statistics were calculated for key outcomes and demographic variables. A detailed review of cases with END was conducted. Of the 138 patients who received TNK, 60 met criteria for inclusion in the initial analysis. The sample was mostly white (71.7%) and male (61.7%) with a median age of 67 (IQR: 52-79). The median NIHSS score was 5 (IQR: 3-6) at initiation and 1 (IQR: 0-3) at 24-hours post TNK. Median length of stay was 3 days (IQR: 2-6). Most patient discharged to home (73.3%) and no patients expired. One person had a symptomatic hemorrhage (1.7%). Six individuals (10%) experienced END within the first 24 of receiving TNK, of those 2 would not have qualified for low frequency monitoring (blood pressure instability and seizure at presentation). Only 2 patients (3.3%) met criteria for END at 24 hours post administration. Our data supports the potential safety of reduced frequency monitoring in patients at low risk for complications following TNK. Among cases reviewed for this analysis, there were no deaths and only one symptomatic bleed. Of note, this individual had additional comorbidities and a history of substance abuse. Reduced frequency monitoring presents an opportunity for a more appropriate level of assessment and monitoring for patients at low risk for complications, ultimately improving the safety, effectiveness and efficiency of stroke care.