Background Real-world evidence comparing Tenecteplase and Alteplase for acute ischemic stroke (AIS) remains limited. This study aimed to evaluate the comparative efficacy and safety of these thrombolytic agents in an unselected patient cohort. Methods This single-center retrospective study analyzed AIS patients undergoing reperfusion therapy. Propensity score matching (PSM) was employed to balance baseline covariates between Tenecteplase and Alteplase groups. The primary outcome was functional independence (modified Rankin Scale 0–2) at 90 days. Safety endpoints included symptomatic intracranial hemorrhage (sICH) and mortality. Results Among 371 eligible patients, 68 (18.3%) received Tenecteplase. In the matched cohort, Tenecteplase demonstrated comparable efficacy to Alteplase regarding functional independence ( p 0.05). Although the incidence of sICH was numerically higher in the Tenecteplase group, the difference was not statistically significant ( p = 0.449). Workflow efficiency, measured by door-to-needle time, was similar between groups. Conclusion Tenecteplase exhibits a non-inferior efficacy and safety profile compared to Alteplase in a real-world setting characterized by high baseline stroke severity. These findings support Tenecteplase as a practical and effective therapeutic alternative for routine AIS management.
Zhang et al. (Tue,) studied this question.