Tenecteplase for acute ischaemic stroke was associated with increased odds of door-to-needle time <30 minutes compared to alteplase (35% vs 11%; aOR 4.165; 95% CI 2.192-7.912; p<0.001).
Observational (n=301)
No
Does tenecteplase reduce door-to-needle time compared to alteplase in patients receiving IV thrombolysis for acute ischaemic stroke?
Routine adoption of tenecteplase for acute ischaemic stroke thrombolysis is associated with significantly shorter door-to-needle times compared to alteplase in a real-world setting.
Effect estimate: aOR 4.165 (95% CI 2.192-7.912)
Absolute Event Rate: 35% vs 11%
p-value: p=<0.001
Abstract Background and aims Our centre switched from alteplase to tenecteplase for IV thrombolysis following guideline recommendations. We compared Door-to-Needle Time (DNT) between agents pre- and post-changeover (February 2025). Methods We extracted routinely collected data from electronic healthcare records for patients who received IV thrombolysis at a university hospital stroke unit between February and November 2024-2025. Patient characteristics and DNT were compared between groups using Fisher’s exact test or chi-squared test of association for categorical variables and Mann-Whitney or Kruskal-Wallis test for continuous variables. We used binary logistic regression models to determine if thrombolytic agent was associated with odds of shorter (30 minutes) or longer (60 minutes) DNT, when adjusted for pre-specified factors (age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score and pre-hospital notification). Results 301 cases received thrombolysis (tenecteplase n=144, alteplase n=157). Patient characteristics were similar between groups (Table1: mean age 70 (95%CI:69-72), male sex n=162 (54%), median baseline NIHSS score 10 (IQR:6-18.75), wake-up onset n=33 (11%) and presentation within Mon-Fri 9am-5pm n=83 (28%)). DNT was significantly shorter with tenecteplase compared to alteplase (median 36mins (IQR:27-49.75) vs 47mins (IQR:35.5-61), p0.001). Tenecteplase was associated with increased odds of DNT30mins compared to alteplase (tenecteplase n=50 (35%) vs alteplase n=18 (11%), aOR=4.165 (95%CI:2.192–7.912), p0.001). There was a trend towards reduced odds of DNT60mins in patients receiving tenecteplase compared to alteplase (aOR:0.546 (95%CI:0.287-1.040), p=0.066). Conclusions In our centre, thrombolysis for acute ischaemic stroke with tenecteplase was associated with shorter DNT compared to thrombolysis with alteplase. Conflict of interest "Mostafa Abdou: nothing to disclose" "Cameron Brown: Nothing to disclose" "Imtiaz M. Shah: Nothing to disclose" "Keith W. Muir: Advisory Boards: Boehringer Ingelheim. Consultancy: Boehringer Ingelheim, Biogen, Hyperfine, Woolsey Pharma Takeda. Lecture Fees: Boehringer Ingelheim, IschemaView, Brainomix. Trial Support: Boehringer Ingelheim (tenecteplase for ATTEST-2). Funding from NIHR, BHF, The Stroke Association, CSO." Table 1 - belongs to Methods Table 2 - belongs to Results Table 3 - belongs to Results
Abdou et al. (2026) conducted an observational in Acute ischaemic stroke (n=301). Tenecteplase vs. Alteplase was evaluated on Door-to-Needle Time (DNT) < 30 minutes (aOR 4.165, 95% CI 2.192-7.912, p=<0.001). Tenecteplase for acute ischaemic stroke was associated with increased odds of door-to-needle time <30 minutes compared to alteplase (35% vs 11%; aOR 4.165; 95% CI 2.192-7.912; p<0.001).
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