A newly approved clot-busting drug for treating strokes may work just as well as the long-used standard medication—and it could offer key advantages for some patients.
Researchers at UT Southwestern Medical Center found that tenecteplase, a newer drug, is just as safe and effective as alteplase, the traditional stroke treatment, and may even help certain patients recover faster. Their study was published in JAMA Network Open.
Why Faster Treatment Matters
Every year, nearly 800,000 people in the U.S. suffer a stroke, most of them caused by a blood clot blocking blood flow to the brain. This type of stroke, called an acute ischemic stroke (AIS), requires urgent treatment to restore blood flow before brain cells die. As Dr. Justin Rousseau, the study’s lead researcher, put it: “Time is brain—the longer treatment is delayed, the more brain damage occurs.”
For decades, hospitals have used alteplase, a drug that dissolves blood clots by activating an enzyme in them. However, alteplase has drawbacks. It is given through an IV in two steps: an initial fast dose, followed by a continuous infusion over an hour.
This process can be complex, sometimes causing delays in care or interruptions in treatment. If a patient needs a procedure to physically remove the clot (endovascular thrombectomy), alteplase can slow the process.
Tenecteplase: A Faster Alternative?
Tenecteplase was approved by the FDA in March as a new option for AIS treatment. It had already been used for heart attacks and was sometimes used off-label for strokes based on promising early research. Unlike alteplase, tenecteplase is given in a single injection that takes just seconds, allowing treatment to begin more quickly.
Despite these advantages, only about 20% of hospitals have adopted tenecteplase as a standard treatment. One reason is the lack of large-scale data from real-world hospital settings.
Dr. Rousseau and his team aimed to fill this gap by analyzing data from the American Heart Association’s Get With The Guidelines—Stroke registry, which collects information from tens of thousands of stroke patients each year.
Comparing the Two Drugs
The researchers examined records from July 2020 to June 2022, looking at 79,550 stroke patients treated at hospitals across the U.S. Of these, 70,085 received alteplase, while 9,465 received tenecteplase.
The findings showed that both drugs were equally effective in key measures, including:
- Functional independence (ability to care for oneself)
- Freedom from major disability
- Likelihood of being discharged home rather than to a rehab facility or hospice
- Independent walking ability after treatment
Safety outcomes were also similar, meaning that neither drug had a higher risk of complications.
A Possible Advantage for Some Patients
For certain patients, tenecteplase seemed to provide an extra benefit. Some people eligible for clot-removal procedures never end up having them—sometimes because they improve significantly after clot-busting drugs, have existing disabilities, or lack access to a specialist.
Among these patients, tenecteplase appeared to improve survival rates and increase the chances of being discharged home rather than to hospice or a rehab center.
What This Means for Stroke Care
These findings could encourage more hospitals to switch to tenecteplase as their standard stroke treatment. Its ease of use and potential to speed up care may make it an attractive alternative to alteplase, especially in hospitals that need to act quickly but may face logistical challenges.
While alteplase remains an effective and widely used drug, tenecteplase’s single-dose administration may help more patients receive treatment sooner—potentially improving outcomes and saving lives.
As more hospitals consider making the switch, further research will help confirm whether tenecteplase can consistently offer advantages over the long-standing standard of care.
If you care about stroke, please read studies about how to eat to prevent stroke, and diets high in flavonoids could help reduce stroke risk.
For more information about health, please see recent studies about how Mediterranean diet could protect your brain health, and wild blueberries can benefit your heart and brain.
The research findings can be found in JAMA Network Open.
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