ORIGINAL Study Summary: Tenecteplase vs Alteplase in Acute Ischemic Stroke

A large multicenter clinical trial in China compared Tenecteplase (0.25 mg/kg) with the standard treatment alteplase (0.9 mg/kg) for patients with acute ischemic stroke (AIS) treated within 4.5 hours of symptom onset.

• Design: 1,489 patients across 55 stroke centers were randomized 1:1 to receive either Tenecteplase or alteplase.

• Primary Outcome: Excellent recovery, defined as a modified Rankin Scale (mRS) score of 0–1 at 90 days.

• Results:

  1. mRS 0–1 at 90 days: 72.7% with Tenecteplase vs 70.3% with alteplase (Tenecteplase met noninferiority).

  2. Symptomatic intracerebral hemorrhage: 1.2% in both groups.

  3. 90-day mortality: 4.6% with Tenecteplase vs 5.8% with alteplase.

Conclusion: Tenecteplase was noninferior to alteplase for functional recovery in AIS and showed a similar safety profile. These results support Tenecteplase as an effective alternative to alteplase for eligible patients.