Background and Purpose
Although many stroke centers in United States are using intravenous (IV) tenecteplase
(TNK) for acute ischemic stroke patients, there is paucity of comparative data between
IV TNK and IV alteplase from real-world settings.
Materials and Methods
We analyzed the data from 122 healthcare facilities in Cerner Real World Data and
included patients admitted between February 2016 to April 2022 to determine the effect
of IV TNK (compared with IV alteplase) on occurrence of two outcomes in acute ischemic
stroke patients stratified by use of thrombectomy: non-routine discharge or death,
and intracranial hemorrhage after adjusting for potential confounders.
Among 30,643 acute ischemic stroke patients analyzed, 29,480 (96.2%) and 1,163 (3.8%)
patients received IV alteplase and IV TNK, respectively. The proportion of patients
who received thrombectomy was significantly higher among patients who received IV
TNK compared with those who received IV alteplase (16.7% versus 11.0%, p<0.001). Occurrence
of intracranial hemorrhage was more common among patients treated with IV TNK in acute
ischemic stroke patients who did not receive thrombectomy (7.9% versus 5.1%, p<0.001)
but not in those who received thrombectomy (20.1% versus 16.8%, p = 0.234). In the logistic regression analysis, patients treated with IV TNK who did
not receive thrombectomy were at higher risk of intracranial hemorrhage (OR, 1.34,
95% CI 1.05-1.72, p = 0.02) after adjusting for age (age strata), gender, race/ethnicity, hypertension,
diabetes mellitus, atrial fibrillation, hyperlipidemia, malignancy, nicotine dependence,
previous ischemic stroke, previous transient ischemic attack, previous intracerebral
hemorrhage, previous subarachnoid hemorrhage, previous acute myocardial infarction,
atherosclerosis of aorta, previous AKI, congestive heart failure, peripheral vascular
disease, and hospital type, aphasia, hemiplegia, neglect, somnolence, stupor and coma,
dysphagia, and homonymous hemianopsia. There was no difference in the rate of non-routine
discharge or death between patients treated with IV TNK and those treated with IV
alteplase in the multivariate analyses.
In an analysis of real-world data, IV TNK was associated with higher rates of intracranial
hemorrhage compared with IV alteplase in patients with acute ischemic stroke who did
not undergo thrombectomy.