ABSTRACT NUMBER: ESOC2026A1613 SAFETY AND EFFECTIVENESS OF TENECTEPLASE AND ALEPLASE IN ACUTE ISCHAEMIC STROKE: DATA FROM THE UK NATIONAL STROKE REGISTRY (SSNAP)

Abstract Background and aims Tenecteplase (TNK) has been shown to be at least non inferior to Alteplase (rtPA) in the emergency treatment in acute ischaemic stroke but real world data is limited in the UK. This study aims to explore the safety and effectiveness of TNK in routine practice over one year. Methods Data from the National Stroke Registry for England, Wales, And Northern Ireland (The Sentinel Stroke National Audit Programme: SSNAP) were analysed for patients with ischaemic stroke treated with TNK and rtPA between October 2024 and September 2025. Results Of 12919 patients who underwent thrombolysis, 8284 (64.1%) received TNK and 4635 (35.9%) received rtPA. There were no differences in NIHSS on arrival (TNK 8, IQR: 5-15 vs rtPA 9, IQR 5-15, P>0.05). Higher rates of patients treated with TNK were thrombolysed within an hour of arrival (60.4% vs 52.8%, P<0.05) with faster door to needle times (53, IQR: 38-76 minutes vs 59, IQR: 42-86 minutes, P<0.05). There were higher rates of patients receiving rtPA who underwent thrombectomy (5.8% vs 6.9%, P<0.05). There were no differences in symptomatic intracranial haemorrhage (TNK: 3.3% vs rtPA: 3.4%, P>0.05). There were no differences in patients independent at discharge (modifed Rankin Score 0-2; TNK 49% vs rtPA 48%, P>0.05) nor inpatient mortality (TNK 10.8% vs rTPA 10.4%, P> 0.05). Conclusions Real world data revealed faster process times with TNK as well as similar effectiveness and safety outcomes supporting the transition of TNK over rtPA as the first line thrombolytic agent. Conflict of interest Kaili Stanley: nothing to disclose; Kevin Vasquez: nothing to disclose; Ajay Bhalla: nothing to disclose; Martin James: I have received speaker fees from Boehringer Ingelheim, the manufacturer of alteplase and tenecteplase.