ISC 2026 | Comparative analysis of prehospital tenecteplase versus alteplase on the mobile stroke unit

So, this is a study on pre-hospital thrombolysis on the mobile stroke unit where we compared tenecteplase versus alteplase. We decided to retrospectively look at some differences between alteplase and tenecteplase because the only study that has been done on the subject in the pre-hospital setting is actually the TASTE-A trial. And the TASTE-A trial is a Phase II randomized open-label trial that was done in Australia comparing and randomizing patients to tenecteplase versus alteplase on the mobile stroke unit in the pre-hospital setting. We have a lot of other studies comparing both those IV thrombolytics in the hospital setting, but we decided to retrospectively look at our data and see whether there’s a difference in functional outcomes and in some of our metrics between tenecteplase and alteplase. So recently, tenecteplase has replaced alteplase as the intravenous thrombolytic of choice in acute ischemic stroke, one, because of its longer half-life, two, because of its greater fibrin specificity, and three, because of its single bolus administration. The aim of our study here was to compare MSU-door to intravenous thrombolytic times and some functional stroke outcomes between tenecteplase and alteplase on the mobile stroke unit. So this was a single-center retrospective review of patients who received intravenous thrombolysis on the mobile stroke unit. We compared tenecteplase, which was given between 2022 and 2025, to alteplase, which was given between 2018 and 2022. Wilcoxon-Rank’s sub-test was used for comparison of key metrics for all the metrics as an unadjusted comparison, and then generalized linear regression models were used to compare MSTU door to IVT, and then controlling for some of the confounders, such as difficulty placing in IV, need for antihypertensive medication, or extended door to CT time. So first of all, when we compare the demographics, there was no difference in age, gender, or the premorbid modified Rankin scale. And then when it comes to the stroke risk factors, we just noticed that hyperlipidemia was actually more common in patients who received tenecteplase. Otherwise, there was no difference in the stroke risk profile between the group that received tenecteplase or alteplase. When it comes to the key metrics, we noticed no statistically significant difference between MSTU door-to-needle or door-to-IV thrombolytic time. The median door-to-IVT time for tenecteplase was 21 minutes, and the median for alteplase was 19 minutes. And that difference did not reach statistical significance. When it comes to functional outcomes, we looked at the discharge modified Rankin scale, the 30-day modified Rankin scale, and the 90-day modified Rankin scale. To note that there was a lot of missing data when we’re talking about functional outcomes. So although we noticed some difference in the 30-day MRS with a shift towards better outcomes with alteplase, we don’t think these results are very reliable because of missing data. So all in all, there was no statistical significant difference noted between MSTU door-to-needle time and functional outcomes when we’re comparing tenecteplase and alteplase in the prehospital setting. Limitations of the study include, of course, its retrospective nature, the time difference between when alteplase was given and tenecteplase was given, and then lack of data on a lot of markers, such as NIH, and then follow-up functional outcomes, as well as the single center nature of this study.

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