Abstract WP24: Safety of Tenecteplase vs Alteplase in Telestroke: A Large Multistate Experience (STAT)

Abstract

Background: Prompt treatment with IV thrombolytics (IVT) in acute ischemic stroke (AIS) patients is critical for improved recovery and survival. Recently, hospital systems are switching to the IVT tenecteplase (TNK) instead of the FDA approved alteplase (tPA) for treatment. Multiple studies and meta-analyses evaluating the efficacy and safety of TNK demonstrate similar or superior outcomes when compared to tPA. TNK is not FDA approved for treatment leading to hesitation and attention on the complications profile including intracranial hemorrhage (ICH) rates. Methods: AIS consults seen in the ED by TeleSpecialists, LLC at 220 facilities (26 states) from January 1, 2022 to May 31, 2023 were extracted from the TeleCare by TeleSpecialists TM database. The encounters were reviewed for IVT candidate, door to needle (DTN) time, IVT used, advanced imaging, LVO, complication occurrence, complication type, symptomatic ICH, and ECASS II ICH score. Comparison of complications was performed between the two groups by IVT: TNK or tPA. Comparison of continuous variables was performed by student’s t-test for normally distributed data, and the Mann-Whitney test for nonnormally distributed data. Pearson's Chi-square test was employed for comparisons of categorical variables. Results: A total of 2305 TNK patients and 3337 tPA patients were extracted. DTN times were faster (37 min vs 42 min, p < 0.0001) and more total complications were seen in the TNK group (87 vs 80, p =0.0035). In nonLVO IVT patients, TNK group had more complications (57 vs 47, p 0.0078), specifically ICH (48 vs 35, p= 0.0036). In LVO IVT patients, TNK group did not have a statistically significant difference in ICH (21 vs 18, p =0.07). In IVT patients not accepted for NIR, TNK group had more complications (77 vs 69, p=0.005), specifically ICH (63 vs 51, p=0.0026). In IVT patients accepted for NIR, no significant differences were observed. There were no statistically significant differences in symptomatic ICH between groups. Conclusions: TNK group was found to have significantly more complications including ICH compared to tPA group driven by non-LVO patients. Closer analysis of potential for increased risk to non-LOV patients is warranted based on this data from the largest simultaneously collected data.