ABSTRACT NUMBER: ESOC2026A986 DOOR-TO-NEEDLE TIMES AFTER ROUTINE TENECTEPLASE ADOPTION

Abstract Background and aims Our centre switched from alteplase to tenecteplase for IV thrombolysis following guideline recommendations. We compared Door-to-Needle Time (DNT) between agents pre- and post-changeover (February 2025). Methods We extracted routinely collected data from electronic healthcare records for patients who received IV thrombolysis at a university hospital stroke unit between February and November 2024-2025. Patient characteristics and DNT were compared between groups using Fisher’s exact test or chi-squared test of association for categorical variables and Mann-Whitney or Kruskal-Wallis test for continuous variables. We used binary logistic regression models to determine if thrombolytic agent was associated with odds of shorter (<30 minutes) or longer (>60 minutes) DNT, when adjusted for pre-specified factors (age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score and pre-hospital notification). Results 301 cases received thrombolysis (tenecteplase n=144, alteplase n=157). Patient characteristics were similar between groups (Table1: mean age 70 (95%CI:69-72), male sex n=162 (54%), median baseline NIHSS score 10 (IQR:6-18.75), wake-up onset n=33 (11%) and presentation within Mon-Fri 9am-5pm n=83 (28%)). DNT was significantly shorter with tenecteplase compared to alteplase (median 36mins (IQR:27-49.75) vs 47mins (IQR:35.5-61), p<0.001). Tenecteplase was associated with increased odds of DNT<30mins compared to alteplase (tenecteplase n=50 (35%) vs alteplase n=18 (11%), aOR=4.165 (95%CI:2.192–7.912), p<0.001). There was a trend towards reduced odds of DNT>60mins in patients receiving tenecteplase compared to alteplase (aOR:0.546 (95%CI:0.287-1.040), p=0.066). Conclusions In our centre, thrombolysis for acute ischaemic stroke with tenecteplase was associated with shorter DNT compared to thrombolysis with alteplase. Conflict of interest "Mostafa Abdou: nothing to disclose" "Cameron Brown: Nothing to disclose" "Imtiaz M. Shah: Nothing to disclose" "Keith W. Muir: Advisory Boards: Boehringer Ingelheim. Consultancy: Boehringer Ingelheim, Biogen, Hyperfine, Woolsey Pharma Takeda. Lecture Fees: Boehringer Ingelheim, IschemaView, Brainomix. Trial Support: Boehringer Ingelheim (tenecteplase for ATTEST-2). Funding from NIHR, BHF, The Stroke Association, CSO." Table 1 - belongs to Methods Table 2 - belongs to Results Table 3 - belongs to Results