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. 2022 Dec;7(4):358-364.
doi: 10.1177/23969873221113729. Epub 2022 Jul 21.

Treatment times, functional outcome, and hemorrhage rates after switching to tenecteplase for stroke thrombolysis: Insights from the TETRIS registry

Gaspard Gerschenfeld  1   2 , Jean-Sébastien Liegey  3 , François-Xavier Laborne  4 , Marion Yger  1   2 , Victoire Lyon  3 , Thomas Checkouri  1   2 , Bertille Tricard-Dessagne  3 , Gaultier Marnat  5 , Frédéric Clarençon  6 , Nicolas Chausson  7 , Guillaume Turc  8 , Igor Sibon  3 , Sonia Alamowitch  1   2   9 , Stéphane Olindo  3
Affiliations

Treatment times, functional outcome, and hemorrhage rates after switching to tenecteplase for stroke thrombolysis: Insights from the TETRIS registry

Gaspard Gerschenfeld et al. Eur Stroke J. 2022 Dec.

Abstract

Introduction: The encouraging efficacy and safety data on intravenous thrombolysis with tenecteplase in ischemic stroke and its practical advantages motivated our centers to switch from alteplase to tenecteplase. We report its impact on treatment times and clinical outcomes.

Methods: We retrospectively analyzed clinical and procedural data of patients treated with alteplase or tenecteplase in a comprehensive (CSC) and a primary stroke center (PSC), which transitioned respectively in 2019 and 2018. Tenecteplase enabled in-imaging thrombolysis in the CSC. The main outcomes were the imaging-to-thrombolysis and thrombolysis-to-puncture times. We assessed the association of tenecteplase with 3-month functional independence and parenchymal hemorrhage (PH) with multivariable logistic models.

Results: We included 795 patients, 387 (48.7%) received alteplase and 408 (51.3%) tenecteplase. Both groups (tenecteplase vs alteplase) were similar in terms of age (75 vs 76 years), baseline NIHSS score (7 vs 7.5) and proportion of patients treated with mechanical thrombectomy (24.1% vs 27.5%). Tenecteplase patients had shorter imaging-to-thrombolysis times (27 vs 36 min, p < 0.0001) mainly driven by patients treated in the CSC (22 vs 38 min, p < 0.001). In the PSC, tenecteplase patients had shorter thrombolysis-to-puncture times (84 vs 95 min, p = 0.02), reflecting faster interhospital transfer for MT. 3-month functional independence rate was higher in the tenecteplase group (62.8% vs 53.4%, p < 0.01). In the multivariable analysis, tenecteplase was significantly associated with functional independence (ORa 1.68, 95% CI 1.15-2.48, p < 0.01), but not with PH (ORa 0.68, 95% CI 0.41-1.12, p = 0.13).

Conclusion: Switch from alteplase to tenecteplase reduced process times and may improve functional outcome, with similar safety profile.

Keywords: Ischemic stroke; acute stroke therapy; process times; tenecteplase; thrombolysis.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All reported disclosures were outside the submitted work. Dr. Laborne reports personal fees from Boehringer Ingelheim. Dr. Marnat reports personal fees from Stryker, Medtronic and Microvention. Prof. Clarençon reports personal fees from Medtronic, Guerbet, Balt Extrusion and Penumbra. Dr. Chausson reports a grant and personal fees from Boehringer Ingelheim and Bristol Myers Squibb. Prof. Sibon reports personal fees from Astra-Zeneca, Bayer, BMS-Pfizer, Boehringer Ingelheim, Elsevier, Novonordisk, Servier and Medtronic. Prof. Alamowitch reports personal fees from the Astra-Zeneca, Bayer, BMS-Pfizer and Elsevier. No other disclosures were reported.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Treatment time metrics and 3-month neurological outcome. CSC: comprehensive stroke center; IVT: intravenous thrombolysis; PSC: primary stroke center. Data are proportion of time (A, B). Statistical analysis: *p < 0.05. ***p < 0.001; n.s., non-significant.
Figure 2.
Figure 2.
Three-month neurological outcome. CSC: comprehensive stroke center; IVT: intravenous thrombolysis; PSC: primary stroke center; tPA: alteplase; TNK: tenecteplase. The dashed lines represent the mRS limit of 2 or less for the neurological outcome. Data are proportion of patients.
See this image and copyright information in PMC

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