Tenecteplase versus alteplase after acute ischemic stroke at high age

Int J Stroke. 2021 Apr;16(3):295-299. doi: 10.1177/1747493020938306. Epub 2020 Jul 6.


Background: Stroke prevalence is increasing with age. Alteplase is the only agent approved for thrombolytic treatment for patients with ischemic stroke, including patients ≥80 years. In the present study, the aim was to compare efficacy and safety of tenecteplase and alteplase in patients ≥80 years.

Methods: Data from the Norwegian Tenecteplase Stroke Trial, a randomized controlled trial comparing alteplase and tenecteplase, were assessed.

Results: Of the 273 patients ≥80 years included, mean age was 85.5 years.In the intention-to-treat analyses, 43.1% receiving tenecteplase and 39.9% receiving alteplase reached excellent functional outcome (modified Rankin Scale score 0-1) after 3 months (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.70-1.85, p=0.59). No significant differences among patients in the two treatment groups regarding frequency of symptomatic intracranial hemorrhage during the first 48 h were identified (11 (8.5%) in the tenecteplase group, 10 (7.0%) in the alteplase group, OR 1.23, 95% CI 0.50-3.00, p 0.65). Death within 3 months occurred in 18 patients (14.3%) in the tenecteplase group and in 21 (15.3%) in the alteplase group (p 0.84). After excluding stroke mimics, the proportion of patients with excellent functional outcome was 44.1% in the tenecteplase group and 34.4% in the alteplase group (OR 1.50 CI 0.90-2.52, p 0.12).

Conclusion: No differences in the efficacy and safety of tenecteplase versus alteplase in patients ≥80 years were identified.

Trial registration: Clinicaltrials.gov (NCT01949948).

Keywords: Tenecteplase; alteplase; ischemic stroke; old age; thrombolysis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged, 80 and over
  • Brain Ischemia* / complications
  • Brain Ischemia* / drug therapy
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Ischemic Stroke*
  • Stroke* / drug therapy
  • Tenecteplase
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Tenecteplase

Associated data

  • ClinicalTrials.gov/NCT01949948