Abstract TP040: Tenecteplase-Associated Complications: A Retrospective Analysis Across a Regional Stroke System

Introduction: Tenecteplase (TNK) is increasingly used for acute ischemic stroke (AIS). TNK has favorable attributes including single-dose administration and lower complication and mortality rates compared to alteplase. This study analyzes post-TNK complication rates (symptomatic intracranial hemorrhage sICH and angioedema) across 19 different hospitals with varying stroke center levels (comprehensive, primary plus, primary and acute stroke ready) within a regional healthcare system. These hospitals went live with TNK in early 2023. Hypothesis: Complication rates may differ between comprehensive, primary plus, primary, and acute stroke ready centers, reflecting variations in resources and expertise. Methods: This was a retrospective, multicenter study (2/23-12/24) of patients experiencing complications (symptomatic ICH or angioedema) within 36 hours of TNK. Data was utilized from Epic and the American Heart Association’s Get with the Guidelines registry. Fisher's exact test compared complication rates across facility types. Results: 19 hospitals were included (11 acute stroke ready, 6 primary plus and primary, and 2 comprehensive). Of 554 TNK administrations, 16 experienced complications (13 sICH, 3 angioedema). Complication rates were not statistically significant across facility types (p=0.051). The overall symptomatic ICH rate was 2.3%. For those with complications, mean time from symptom onset to TNK was 115.2 (±51.8) minutes, and door-to-needle time was 59.7 (±39.8) minutes. Conclusion: Post-TNK complication rates were similar (not statistically significant) across stroke center levels, suggesting comparable safety profiles regardless of facility resources. Additionally, rates of complications were similar to published data by larger academic settings. These findings support TNK use in diverse settings, but vigilance for complications remains crucial.