Abstract DP301: Alteplase vs. Tenecteplase: Comparison of Treatment Times and Hemorrhagic Complications in a large US health care system

Introduction: Tenecteplase (TNK) has multiple benefits over tissue plasminogen activator (tPA) including ease of administration, increased recanalization in LVO and cheaper cost. Meta-analysis of TNK vs. tPA showed that TNK may offer superior functional outcomes with similar safety as tPA in randomized clinical trials (Katsanos et al Stroke 2020 and Lina Palaiodimou et al Neurology, 2024). Seeing real world data for tPA vs TNK will add to the knowledge base in a unique way compared with existing randomized clinical trials. Methods: A retrospective analysis of adult, acute ischemic stroke patients from a large US health care system between Jan 2018 and May 2024 was initiated to explore differences in time metrics and safety outcomes in patients treated with thrombolytics. August 1 st , 2021 was considered the date of transition for this healthcare system from tPA to TNK. Patients were excluded, if the interval from onset to thrombolytic (IVT) administration exceeds 4.5 hours, arrived by transfer, stroke occurred during hospitalization or treated during the drug transition period of 1 month before and 1 month after August 1st, 2021. Time metrics: DTN: door-to-needle time and DTD: door-to-device time and safety outcomes: sICH: symptomatic IHC < 36 hours and ltHEM: life-threatening, serious systemic hemorrhage < 36 hours, were compared for patients treated with tPA and TNK. Age and NIHSS score at admission corrected linear and logistic mixed-effect models, were used to compare time metrics (DTN and DTD) and safety outcomes (sICH and ltHEM) between the 2 thrombolytic treatments (tPA and TNK). Results: Of the 1,402 AIS patients analyzed Median DTN was 35 minutes (IQR: 25-46) and median DTD (min) was 103 minutes (IQR: 81-131); 78 (5.6%) had sICH and 545 (88%) had ltHEM. Table2 In unadjusted and adjusted models, TNK treatment was associated with shorter DTN and shorter DTD and lower likelihood of ICH events. The models adjusted age and NIHSS score show statistical significance difference that favors TNK treatment for DTN (beta -3.7, 95%CI -5.5, -1.9, p <0.001), DTD (beta -17, 95%CI -21, -13, p <0.001). Table3 Conclusions: In a large real world sample, IV TNK was associated with better time metrics (DTN and DTD) and better safety outcomes compared to IV alteplase. IV TNK is $1715.53 cheaper on average in our large multi-state system compared to alteplase. Therefore, the IV TNK cohort studied here (n=781) represents 1.34 million dollars in savings