Abstract 4: Thrombolysis with Tenecteplase in Minor Disabling versus Non-disabling Stroke: Secondary Analysis of the TEMPO-2 Trial
Bibliographic record
Abstract
Introduction: The tenecteplase versus standard of care for minor ischemic stroke with proven occlusion (TEMPO-2) trial showed that patients presenting with minor deficits up to 12 h do not benefit from intravenous thrombolysis. The trial included patients with minor but disabling deficits, mainly beyond 4.5 h, if they were not eligible for standard-of-care thrombolysis. We aimed to determine if intravenous tenecteplase improves outcomes in this subgroup of TEMPO-2 patients with disabling deficits. Methods: This was an exploratory secondary analysis of the TEMPO-2 trial, which randomized patients across 48 hospitals globally with minor acute ischemic stroke (NIHSS score 0-5) and intracranial occlusion or focal perfusion abnormality within 12 h from stroke onset to intravenous tenecteplase (0.25 mg/kg) or non-thrombolytic standard of care. Adopting an available definition for disabling stroke from the TREAT Task Force consensus (Table 1), we compared efficacy and safety outcomes between treatment arms for participants with non-disabling versus disabling syndromes at presentation. Results: Among 886 patients, 786 (88.7%) and 100 (11.3%) were identified to have non-disabling and disabling deficits, respectively. Patients with disabling deficits had higher baseline NIHSS scores (4 vs 2, P<0.001), later presentations (288min vs 133min, P<0.001) and longer onset to treatment time (411min vs 278min, P<001). There was no evidence of treatment effect heterogeneity between disabling and non-disabling groups (P interaction = 0.22). However, there were nominally fewer excellent outcomes at 90 days (mRS 0-1) with tenecteplase compared with standard of care in the disabling group (non-disabling: 72.0% vs 72.5%, P=0.936; disabling: 47.2% vs 61.7%, P=0.164). No difference in symptomatic ICH was found but an interaction existed with treatment arms and presence of disabling stroke regarding any hemorrhage on follow-up neuroimaging (non-disabling: tenecteplase 13.5% vs control 10.0%, P=0.146; disabling: tenecteplase 20.8% vs control 2.1%, P=0.005. P interaction = 0.049). Conclusions: The TREAT Task Force definition of disabling stroke did not modify the neutral treatment effect of intravenous tenecteplase in patients with minor stroke and intracranial occlusion. Fewer excellent outcomes after intravenous tenecteplase were observed in the disabling deficits group, possibly due to longer times to presentation and thrombolysis for the disabling subgroup.
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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 | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
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".