Efficacy and safety of tenecteplase versus urokinase in the treatment of acute ischemic stroke

Acute ischemic stroke is a time-critical condition in which timely and effective intravenous thrombolysis is essential for improving neurological recovery and long-term functional outcomes. This retrospective observational study compared the clinical efficacy and safety of tenecteplase and urokinase in consecutive patients with acute ischemic stroke treated between January 2023 and December 2024. Patients were allocated to a Tenecteplase group (n = 78) or a Urokinase group (n = 82) according to the thrombolytic agent administered. Baseline demographic, vascular risk, clinical, and imaging characteristics were well balanced between groups. Early outcomes included vessel recanalization, 24-hour change in National Institutes of Health Stroke Scale (NIHSS) score, and early neurological improvement (NIHSS decrease ≥4 points). Functional outcome at 90 days was assessed using the modified Rankin Scale, while safety endpoints comprised intracranial hemorrhage (ICH), extracranial bleeding, serious adverse events, and mortality. Tenecteplase was associated with a significantly higher recanalization rate (59.0% vs 41.5%), greater 24-hour NIHSS improvement (mean ΔNIHSS 4.8 vs 3.2), and a higher proportion of patients achieving good functional outcome at 90 days (modified Rankin Scale 0-2: 84.6% vs 67.1%) compared with urokinase. Rates of ICH, symptomatic ICH, extracranial bleeding, serious adverse events, and in-hospital and 90-day mortality did not differ significantly between groups. These findings suggest that tenecteplase provides superior clinical benefit over urokinase without compromising safety in eligible patients with acute ischemic stroke.