Effectiveness and safety of tenecteplase for acute ischaemic stroke at primary stroke centres: a multicentre retrospective study

Background Evidence regarding tenecteplase (TNK) use at primary stroke centres (PSCs) remains limited. PSCs often serve as the initial or sole point of care for acute ischaemic stroke (AIS) patients. We aimed to assess the effectiveness and safety of TNK at PSCs. Methods Consecutive AIS patients receiving TNK or alteplase within 4.5 hours at PSCs in China from 1 January to 31 December 2023 were included retrospectively. Propensity score matching (PSM) was used to match TNK-treated and alteplase-treated patients 1:1 and their effectiveness and safety were compared. The primary effectiveness outcome was modified Rankin Scale (mRS) 0–1 at 90 days, while the key safety outcome was post-thrombolysis symptomatic intracranial haemorrhage (sICH). Results We included 4000 cases from 62 PSCs (TNK: 1670; alteplase: 2330). After PSM, 1552 cases per group were analysed. There was no significant difference between the two groups in the proportion of patients achieving mRS 0–1 at 90 days (69.7% vs 70.9%, p=0.472). No differences in functional outcome or sICH were observed in adjusted analyses. Exploratory subgroup analyses suggested a potential association between TNK and improved outcomes in patients with large artery atherosclerosis (LAA). Conclusions TNK showed comparable effectiveness and safety to alteplase for AIS patients at PSCs. Exploratory subgroup findings in LAA require confirmation in future prospective studies.