TENECTEPLASE VS. ALTEPLASE IN ACUTE ISCHEMIC STROKE: A SUPERIOR ALTERNATIVE BACKED BY EVIDENCE

Pasupuleti Kishore Kumar*, Prabhdeep Kaur, P. Neerajakshi, G. Nivas Kumar and T. Rama Rao

ABSTRACT

Background: Intravenous thrombolysis is a cornerstone of acute ischemic stroke (AIS) management. Alteplase (tPA) has long been the standard of care; however, tenecteplase (TNK), a genetically modified variant with greater fibrin specificity and a longer half-life, is emerging as a potential alternative. Objective: To compare the efficacy, safety, and practicality of tenecteplase versus alteplase in treating acute ischemic stroke. Methods: A comprehensive review of randomized controlled trials, observational studies, and meta-analyses published over the past decade was conducted to evaluate clinical outcomes, including recanalization rates, functional independence at 90 days (measured by modified Rankin Scale), symptomatic intracranial hemorrhage (sICH), and overall mortality. Administration protocols and pharmacokinetic properties were also examined. Results: Several recent trials (e.g., EXTEND-IA TNK, NOR-TEST) suggest that tenecteplase is at least non-inferior and potentially superior to alteplase in terms of early recanalization and neurological improvement. Tenecteplase has shown a favorable safety profile with similar or lower rates of sICH. Its single-bolus administration simplifies logistics, especially in pre-hospital and resource-limited settings. Conclusion: Tenecteplase represents a promising alternative to alteplase for intravenous thrombolysis in AIS, offering comparable or improved clinical outcomes with enhanced ease of use. Ongoing large-scale trials are expected to solidify its role in future stroke protocols and potentially redefine standard care practices.

Keywords: Tenecteplase, Alteplase, Acute ishemic stroke, Superiority, Myocardial infarction.