Deans' stroke musings: Tenecteplase Shows No Benefit in Minor Ischemic Stroke With Disabling Deficits

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, November 25, 2025

Tenecteplase Shows No Benefit in Minor Ischemic Stroke With Disabling Deficits

Well, your competent? doctor better have EXACT PROTOCOLS to treat your stroke regardless of severity. You better ask NOW, just to make sure your doctor and hospital KNOW EXACTLY WHAT TO DO when you show up with a stroke. They've been incompetent on stroke for decades, have them prove their competency before you need it!

Tenecteplase Shows No Benefit in Minor Ischemic Stroke With Disabling Deficits

Tenecteplase did not improve 90-day functional outcomes in patients with minor ischemic stroke, including those with disabling deficits, and increased the risk for hemorrhage in the disabling-deficit subgroup.

Intravenous tenecteplase does not improve 90-day outcomes compared with standard medical care among patients with minor ischemic stroke and disabling deficits, according to findings published in JAMA Neurology.In this secondary analysis of the TEMPO-2 trial (ClinicalTrials.gov Identifier: NCT02398656), researchers evaluated whether tenecteplase (0.25 mg/kg) improved functional recovery in adults presenting within 12 hours with minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5) and proven intracranial occlusion or perfusion deficit.

The multicenter, prospective, open-label, randomized trial was conducted across 48 global sites between April 2015 and January 2024. Of 886 enrolled patients, 884 were included after 2 withdrew consent. Patients were followed for 90 days and retrospectively categorized as having disabling or nondisabling deficits based on The REexamining Acute Eligibility for Thrombolysis (TREAT) Task Force criteria.

Together with converging evidence comparing intravenous thrombolysis to nonthrombolytic standard of care, this analysis suggests the need to reevaluate thrombolysis in minor disabling stroke.

The median age of participants was 72 years (IQR, 61–80), and 41.7% were women. Overall, 11.3% had disabling deficits and 88.7% had nondisabling deficits. Patients with disabling deficits had higher baseline NIHSS scores, with a median score of 4 (IQR, 3-5) compared with 2 (IQR, 1-3) in the nondisabling group. They also had longer onset-to-treatment times, with a median time of 411 (IQR, 307-560) minutes compared with 278 (IQR, 170-462) minutes. Time from symptom onset to hospital arrival was also longer in the disabling-deficit group, with a median of 288 (IQR, 153-412) minutes compared with 133 (IQR, 70-310) minutes.

In the disabling-deficit subgroup, 53 patients received tenecteplase and 47 received standard care. The primary outcome, defined as a return to baseline modified Rankin Scale (mRS) score at 90 days, was achieved in 54.7% of patients treated with tenecteplase and 68.1% of those who received standard care (adjusted risk ratio [aRR], 0.81; 95% CI, 0.60-1.10). Similarly, no difference was observed in the nondisabling group (73.9% vs 75.6%; aRR, 0.98; 95% CI, 0.91-1.07). The effect of tenecteplase did not differ between subgroups (P =.32).

Secondary outcomes, including excellent outcomes (mRS, 0-1) and functional independence (mRS, 0-2) at 90 days, also showed no significant differences between treatment groups in either disability category. However, any hemorrhage detected on follow-up imaging was significantly more frequent in the disabling group receiving tenecteplase, occurring in 21% compared with 2% of those receiving standard care (aRR, 9.79; 95% CI, 1.15-83.29).

Across multiple definitions of disability, including those from the Antiplatelet vs R-tPA for Acute Mild Ischemic Stroke (ARAMIS) trial and National Institute of Neurological Disorders and Stroke trials, the neutral treatment effect persisted.Study limitations include a post hoc design, absence of cognitive outcomes, the short 90-day follow-up, and the fact that the analysis was not powered to detect subgroup differences.

“Together with converging evidence comparing intravenous thrombolysis to nonthrombolytic standard of care, this analysis suggests the need to reevaluate thrombolysis in minor disabling stroke,” the study authors concluded.

Disclosures: This research was supported by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the British Heart Foundation. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.