Tenecteplase May Speed Up Stroke Thrombolysis and Transfers: Study

A new study published in the Journal of American Medical Association showed that shorter door-to-needle (DTN) and door-in-door-out (DIDO) timings are linked to the use of tenecteplase rather than alteplase for IV thrombolysis in acute ischemic stroke.

Reperfusion treatment must be started as soon as possible for acute ischemic stroke in order to improve patient outcomes. Door-to-needle and door-in-door-out timings are often used to gauge workflow efficiency. In US hospitals, tenecteplase has gradually taken the position of alteplase. Tenecteplase has far quicker preparation and administration times because it just needs a brief 5- to 10-second bolus, as opposed to alteplase's bolus with a 60-minute infusion.

In addition to reducing important treatment delays, this simplified delivery has the potential to significantly cut DTN and DIDO times. The study evaluated workflow metrics between stroke patients receiving alteplase and tenecteplase in order to assess this.

The Get With The Guidelines-Stroke registry of the American Heart Association provided data for this cohort research between July 1, 2020, and June 30, 2022. Adult ischemic stroke patients who had intravenous thrombolysis were included in the analysis.

Door-to-needle time for patients who came straight to the reporting hospital and door-in-door-out time for patients who were moved following thrombolytic treatment were the main results. Door-to-puncture and other endovascular process parameters were secondary outcomes for patients receiving thrombectomy following thrombolysis. The relationship between thrombolytic therapy and workflow time interval results was evaluated using generalized linear mixed models.

Tenecteplase considerably reduced treatment times as compared to alteplase in an investigation of more than 133,000 stroke patients. 

Tenecteplase enhanced the probability that patients would get treatment within the crucial 30-, 45-, and 60-minute goal windows and consistently decreased average door-to-needle delays. 

It was also linked to faster procedural milestones and hospital transfer times for patients who needed mechanical thrombectomy. 

Additionally, the total treatment speeds of the institutions that switched to tenecteplase during the trial period immediately improved.

Overall, researchers discovered that therapy with tenecteplase, as opposed to alteplase, was linked to faster DTN and DIDO periods in this cohort analysis of stroke patients receiving tenecteplase from a sizable national registry. Both hospitals that do MT on-site and those that send patients for MT elsewhere can benefit from the increased use of tenecteplase for stroke thrombolysis due to these operational improvements.

Source:

Warach, S. J., Weber, J. M., Alhanti, B., Messé, S. R., Schwamm, L. H., Fonarow, G. C., Sheth, K. N., Smith, E. E., Mullen, M. T., Silva, G. S., Mac Grory, B., Xian, Y., & Saver, J. L. (2026). Tenecteplase vs alteplase and time to treatment for acute ischemic stroke. JAMA Network Open, 9(7), e2623260. https://doi.org/10.1001/jamanetworkopen.2026.23260