Abstract WP056: Safety of Tenecteplase v Alteplase in Telestroke: Assessment for Reproducibility (STAT 2.0)

Abstract

Background: Acute ischemic stroke (AIS) is a neurological emergency requiring prompt response to treatment. Alteplase (tPA) was the gold standard intravenous thrombolytic (IVT), but the newly FDA approved tenecteplase (TNK) has gained popularity as a first-line treatment. Our previous publication showed that patients receiving TNK had overall more complications and rates of ICH compared to patients receiving tPA namely in non-large vessel occlusion (LVO) stroke patients. The purpose of this study was to determine reproducibility of our results in a large, multistate and multicenter patient population where TNK has now become the IVT of choice. Methods: AIS consults seen in the ED between January 1, 2024 and December 31, 2024, were extracted from the TeleSpecialists TeleStroke Registry™. The encounters were reviewed for IVT candidate, door to needle (DTN) time, IVT used, advanced imaging, LVO, complication occurrence, type of complication, neurointervention radiology (NIR) candidate. Comparison of complications was performed between the two groups by IVT treatment. Comparison of continuous variables was performed by student’s t-test for normally distributed data, and the Mann-Whitney test for non-normally distributed data. Pearson's Chi-square test was employed for comparisons of categorical variables. Results: A total of 6450 patients were extracted with 5270 receiving TNK and 1180 receiving tPA. DTN times were faster (41 min v0 42 min, p=0.007). While there were more overall complications (2.45% v 1.86%, p=0.275) it did not reach statistical significance, but the rates of ICH (1.92% v 1.02%, p=0.0448) were significantly higher in the TNK group. The overall increase in complications trend was seen throughout all groups (complications and ICH rates, respectively): non-LVO group (2.24% v 1.86%, p=0.5693) and (1.79% v 1.05%, p=0.1595), LVO group (3.26% v 1.78%, p=0.2902) and (2.46% v 1.33%, p=0.3429), patients with LVO accepted for NIR (3.75% v 1.56%, p=0.2845) and (3.07% v 1.56%, p=0.5539), patients with LVO not accepted for NIR (2.73% v 2.06%, p=0.9999) and (2.19% v 1.03%, p=0.7032). Conclusions: Rates of ICH in all groups were lower than what we originally published with 3.12% v 1.92% within the TNK group and 1.38% v 1.02% in the tPA group, but again significantly higher in the TNK group. Unlike our previous paper, we did not see any statistically significant differences between non-LVO and LVO groups. Further analysis to assess impact on outcomes is in process.

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