E-230 Tenecteplase versus alteplase before stroke thrombectomy: outcomes after system-wide transitions in pennsylvania
Bibliographic record
Abstract
Background and Purpose Healthcare systems in the United States are increasingly transitioning from alteplase (TPA) to tenecteplase (TNK) as primary thrombolytic in acute ischemic stroke care. We explore the safety and effectiveness of replacing TPA with TNK before large vessel occlusion (LVO) stroke endovascular treatment (EVT). Methods Retrospective multicenter cohort study of LVO stroke patients who received intravenous thrombolysis with TPA or TNK before EVT across healthcare systems in Pennsylvania between 01/2020 - 06/2023. All stroke systems transitioned to TNK during the study period. Multivariate logistic analysis was conducted with pre-specified adjustments for age, sex, National Institute of Health Stroke Scale (NIHSS), occlusion site, last-known-well (LKW) to intravenous thrombolysis time (IVT), interhospital-transfer and stroke-system. Of 851 identified patients, 635 met prespecified analysis criteria (proximal LVO, pre-stroke modified Rankin Scale (mRS) < 3, LKW-to-IVT ≤ 4.5 hours). Results Of 635 patients, 309 (48.7%) received TNK and 326 (51.3%) TPA prior to EVT. The site of occlusion was the M1 (MCA) (47.7%), M2 MCA (25.4%), ICA (14.0%), tandem carotid with M1 or M2 MCA (9.8%) and BA (3.1%). TNK and TPA patients had similar age, sex, NIHSS, occlusion sites, Alberta Stroke Program Early CT Score (ASPECT), and LWK-to-IVT. A favorable functional outcome (90-day mRS < 3) was observed in 47.6% of TNK and 49.7% of TPA patients (aOR 0.72 (95% CI 0.47 - 1.10), p=0.132). TNK versus TPA groups had similar rates of successful endovascular reperfusion (93.5% vs. 89.3%, aOR 1.19 (0.58 - 2.43), p=0.627), symptomatic intracranial hemorrhage (3.2% vs. 3.4%, aOR 0.54 (0.20 - 1.44, p=0.218) and 90-day all-cause mortality (23.1% vs. 21.5%, aOR 1.21 (0.71 - 2.06, p=0.491). Conclusions In this U.S. real-world multicenter experience, TNK compared to TPA before LVO stroke EVT had similar safety and effectiveness profiles. Disclosures P. Hendrix: None. B. Gross: None. S. Allahdadian: None. G. Sioutas: None. P. Koul: None. A. Tarbay: None. M. Lang: None. V. Srinivasan: None. A. Al-Bayati: None. J. Li: None. A. Noto: None. R. Nogueira: None. J. Burkhardt: None. R. Zand: None. C. Schirmer: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".