WSC 2023 | ATTEST2: alteplase versus tenecteplase for stroke thrombolysis

Keith Muir, MD, PhD, Queen Elizabeth University Hospital, Glasgow, UK, gives an update on the multicenter ATTEST2 trial (NCT02814409) comparing thrombolytic agents, alteplase versus tenecteplase, for reperfusion therapy after acute ischemic stroke. Over the course of seven years, this trial enrolled over 1,800 patients, randomly assigning them to receive either alteplase or tenecteplase treatment within 4.5 hours of stroke symptom onset. After a 90-day period, patients were assessed on their level of disability using the modified Rankin scale. Tenecteplase demonstrated non-inferiority to the more commonly used alteplase. In line with several other trials, this finding may further encourage a shift in clinical practice, favoring tenecteplase due to its ease of administration. The study did not, however, establish the superiority of tenecteplase. Prof. Muir attributes this to a lack of statistical power within a single study to reveal the subtle advantage of tenecteplase. However, he suggests that if the results of numerous studies comparing alteplase and tenecteplase were combined in a meta-analysis, the superiority of tenecteplase may become clear. This interview took place at the World Stroke Congress (WSC) 2023 in Toronto, Canada.

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