Tenecteplase was associated with lower rates of symptomatic intracranial hemorrhage when compared with alteplase, according to preliminary study findings presented at the International Stroke Conference 2022.

“Despite pharmacological and practical advantages for tenecteplase over alteplase, no differences were observed in percent of symptomatic intracranial hemorrhage (sICH) in randomized trials,” wrote Steven J. Warach, MD, Ascension Healthcare and University of Texas at Austin, and co-researchers.

Using an international registry called the CERTAIN collaboration, Dr Warach et al compared rates of sICH in patients treated with tenecteplase or alteplase. The CERTAIN collaboration collects data from programs in New Zealand, Australia, and the United States dating back to July 1, 2018.

Dr Warach et al used standardized data from local and regional clinical registries (n = 7891), and defined sICH as clinical worsening of ≥4 points on National Institute of Health Stroke Scale (NIHSS). Patients receiving tenecteplase treatment were older, tended to be male, had higher scores on NIHSS, and underwent mechanical thrombectomy more often than those receiving alteplase.

Recipients of alteplase and tenecteplase had a sICH rate of 3.71% and 2.13%, respectively. Among patients who did not receive thrombectomy after thrombolytic, sICH rates were 3% and 1.74% with alteplase and tenecteplase, respectively, and among those who did have thrombectomy, sICH rate were 6.80% and 2.80%.

“In this preliminary analysis from a large, multicenter registry, ischemic stroke treated with tenecteplase was associated with a lower rate of sICH than with alteplase,” concluded Dr Warach et al.

Warach, Steven J. Comparative effectiveness of routine tenecteplase thrombolysis in acute stroke compared with alteplase: an international collaboration (CERTAIN Collaboration): rates of symptomatic intracranial hemorrhage. Presented at: International Stroke Conference 2022; February  9-1, 2022; Virtual.