Tenecteplase Versus Alteplase Between 3 and 4.5 Hours in Low National Institutes of Health Stroke Scale

I consider both to be failures since good functional outcome is not the endpoint that should be measured. 100% recovery is the only goal.  Whom is going to be the leader that tackles the BHAGs(Big Hairy Audacious Goals) of 100% recovery for all survivors? Ask a survivor if they consider a good functional outcome what they wanted. Do you NEVER talk to survivors? Stop perpetuating the tyranny of low expectations.

Tenecteplase Versus Alteplase Between 3 and 4.5 Hours in Low National Institutes of Health Stroke Scale

Ole Morten Rønning

,

Nicola Logallo

,

Bente Thommessen

,

Håkon Tobro

,

Vojtech Novotny

,

Christopher E. Kvistad

,

Anne Hege Aamodt

,

Halvor Næss

,

Ulrike Waje-Andreassen

,

Lars Thomassen

Originally published3 Jan 2019https://doi.org/10.1161/STROKEAHA.118.024223Stroke. 2019;0:STROKEAHA.118.024223

Abstract

Background and Purpose—

Thrombolysis with alteplase has beneficial effect on outcome and is safe within 4.5 hours. The present study compares the efficacy and safety of tenecteplase and alteplase in patients treated 3 to 4.5 hours after ischemic stroke.

Methods—

The data are from a prespecified substudy of patients included in The NOR-TEST (Norwegian Tenecteplase Stroke Trial), a randomized control trial comparing tenecteplase with alteplase.

Results—

The median admission National Institutes of Health Stroke Scale for this study population was 3 (interquartile range, 2–6). In the intention-to-treat analysis, 57% of patients that received tenecteplase and 53% of patients that received alteplase reached good functional outcome (modified Rankin scale score of 0–1) at 3 months (odds ratio, 1.19; 95% CI, 0.68–2.10). The rates of intracranial hemorrhage in the first 48 hours were 5.7% in the tenecteplase group and 6.7% in the alteplase group (odds ratio, 0.84; 95% CI, 0.26–2.70). At 3 months, mortality was 5.7% and 4.5%, respectively. After excluding stroke mimics and patients with modified Rankin scale score of >1 before stroke, the proportion of patients with good functional outcome was 61% in the tenecteplase group and 57% in the alteplase group (odds ratio, 1.24; 95% CI, 0.65–2.37).

Conclusions—

Tenecteplase is at least as effective as alteplase to achieve a good clinical outcome in patients with mild stroke treated between 3 and 4.5 hours after ischemic stroke.

Clinical Trial Registration—

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01949948.