Similar 90-day functional outcomes for tenecteplase vs alteplase before thrombectomy in patients 80 and older

Similar 90-day functional outcomes for tenecteplase vs alteplase before thrombectomy in patients ≥80 with large-vessel occlusion stroke (mRS ≤3: 48.0% vs 43.5%; OR 1.20, 95% CI 0.86–1.67).

• Primary outcome showed no significant difference between tenecteplase and alteplase for modified Rankin Scale ≤3 at 90 days (48.0% vs 43.5%; OR 1.20, 95% CI 0.86–1.67), with similar mortality and symptomatic intracranial hemorrhage.
• A single secondary endpoint—complete early neurological recovery (NIHSS 0 at 24 hours)—favored tenecteplase (10.3% vs 2.6%), but the authors flag it as hypothesis-generating and vulnerable to ascertainment bias.
• Propensity-matched retrospective analysis of 278 pairs from 720 eligible patients; treatment was completely confounded with center, so analyses compare cohorts rather than isolate a drug effect.

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