ABSTRACT NUMBER: ESOC2026A2442 TENECTEPLASE VERSUS ALTEPLASE IN ACUTE ISCHEMIC STROKE: A REAL-WORLD COMPARATIVE STUDY

Abstract Background and aims Randomized trials have established tenecteplase as a non-inferior alternative to alteplase for intravenous thrombolysis in acute ischemic stroke (AIS), with comparable safety and simplified administration. These findings have led to increasing adoption of tenecteplase in routine clinical practice. However, real-world data directly comparing clinical outcomes between both agents remain limited. We compared neurological and functional outcomes between tenecteplase and alteplase in AIS patients treated in routine care. Methods We performed a retrospective observational study including AIS patients treated with intravenous thrombolysis in 2025. Patients received either tenecteplase (n=16) or alteplase (n=69). Baseline functional status (mRS), stroke severity at admission (NIHSS), door-to-needle time, hemorrhagic transformation and outcomes at hospital discharge (NIHSS, mRS) were analysed. Descriptive statistics were used to characterize the study population, and group comparisons were performed using non-parametric tests. Results Baseline pre-stroke mRS and admission NIHSS were similar between groups. Median door-to-needle time was 37 minutes [23–52] in tenecteplase group and 28 minutes [17–48] in alteplase group (p=0.212). At discharge, median NIHSS was 2 [0–6] with tenecteplase and 3 [1–6] with alteplase (p=0.505). Functional outcomes were comparable, with median mRS scores of 1 [0–4] and 3 [1–4], respectively (p=0.358). Neurological improvement did not differ significantly between treatments (p=0.478). Hemorrhagic transformation rates were low and similar. Conclusions In this preliminary real-world cohort, tenecteplase and alteplase showed comparable neurological recovery, functional outcomes, and safety at hospital discharge, supporting tenecteplase as a viable alternative in routine clinical practice, although its implementation should be continuously monitored in routine clinical practice. Conflict of interest The authors have nothing to disclose