ABSTRACT NUMBER: ESOC2026A492 TENECTEPLASE ASSOCIATED COAGULOPATHY IN ISCHEMIC STROKE PATIENTS

Abstract Background and aims Tenecteplase (TNK) is increasingly used for intravenous thrombolysis in acute ischemic stroke; however, data on its effects on systemic coagulation and fibrinolysis in the hyperacute phase are limited. We aimed to describe the temporal profile of TNK-associated coagulopathy using fibrinogen measurements and rotational thromboelastometry (ROTEM). Methods We consecutively enrolled patients with acute ischemic stroke treated with intravenous TNK. Plasma fibrinogen was measured at baseline, 1, 6, 12, and 24 hours after TNK administration. ROTEM was performed 1 and 6 hours after bolus. Hyperfibrinolysis was defined by EXTEM maximum lysis (ML) ≥15%/LI60 <85% and evaluated using EXTEM and APTEM assays. Results Thirty-one patients were included (59% male). At 1 hour after TNK administration, all patients (100%) showed hyperfibrinolysis on ROTEM. At 6 hours, persistent hyperfibrinolysis was observed in 4/31 patients (12.9%) (Table 1) Severe hypofibrinogenemia (<100 mg/dL) occurred in 1 patient (3.1%), while 11 patients (35%) developed fibrinogen levels <200 mg/dL or a reduction >50% from baseline. Fibrinogen levels reached a nadir at 6 hours, with a median reduction of 17.5% relative to baseline (Figure 1). Conclusions TNK administration is associated with a transient hyperfibrinolytic state, which resolves in most patients within 6 hours, accompanied by concomitant reduction in fibrinogen levels. Early viscoelastic monitoring may help to tailor the management of bleeding complications in these patients and guide post-thrombolysis adjunctive therapies. Conflict of interest Urbinati Giacomo: nothing to disclose, Forlivesi Stefano: nothing to disclose, Paolucci Matteo: nothing to disclose, Gentile Mauro: nothing to disclose, Migliaccio Ludovica: nothing to disclose, Sebastiani Mario: nothing to disclose, Viola Marilina: nothing to disclose, Brancaleoni Laura: nothing to disclose, Matteo Eleonora: nothing to disclose, Zini Andrea: nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Results