1.Tenecteplase versus alteplase (TENVALT): A study comparing two thrombolytic agents in acute ischemic stroke
Kaushik Sundar ; Lomesh Bhirud ; Ajay Panwar ; Jerin Jose Cherian ; Eldho Mathew Paul ; Gigy Varkey Kuruttukulam
Neurology Asia 2019;24(3):203-208
Background & Objective: The Indian data comparing the efficacy and safety outcomes of tenecteplase
and alteplase in acute ischemic stroke is scarce. We aimed to compare the outcomes of two agents in
an Indian population. Methods: TENVALT study was a single centre, retrospective study. Patients aged
18 years or older with acute ischemic stroke were included in this study if they presented within 3
hours of symptom onset and had a deficit with National Institute of Health Stroke Scale (NIHSS) score
> 4, had a modified Rankin score (mRS) of 2 or less before the stroke onset and had no evidence of
hemorrhage on non-contrast computed tomography of brain. A good functional recovery (mRS score
of 0-2) at the end of three months was defined as the primary efficacy outcome. The development of
symptomatic intracerebral hemorrhage was considered as the primary safety outcome. Results: A total
of 120 patients (alteplase, n=65; tenecteplase, n=55) underwent stroke thrombolysis during this study.
The mean age of the presentation in tenecteplase group was 66.6 years and in alteplase group was
62.5 years. Most of the study subjects were males in both the groups (tenecteplase, 78.2%; alteplase,
61.5%). Hypertension was the most common comorbidity in both the groups (tenecteplase, 67.3%;
alteplase, 76.9%). Median mRS score at 3 months of follow up was 2 in tenecteplase and 1 in alteplase group; however, the difference between the total number of patients having good functional recovery (mRS 0-2) in the two groups was not statistically significant (tenecteplase 74.5 vs alteplase 87.7%, P=0.09). The total number of patients who had symptomatic intracranial hemorrhage was comparable between the two groups (tenecteplase, 5.5%; alteplase, 6.2%). Conclusion: Tenecteplase appears to be an efficacious alternative to alteplase for stroke thrombolysis and may be better suited to developing countries considering its low cost and ease of administration.