The bolus thrombolytic, tenecteplase, given at a dose of 0.25 mg/kg, was noninferior to the standard of care, alteplase, in a large, randomized trial.
The 1600-patient Canadian Alteplase Compared to Tenecteplase (ACT) trial is the largest trial of tenecteplase so far conducted, and the investigators hope it will change clinical practice.
The study was presented by Rick Swartz, MD, director of the Stroke Research Unit at Sunnybrook Health Sciences Centre and of the University of Toronto Stroke Program, and Bijoy Menon, MD, professor of neurology at the University of Calgary, Alberta, Canada, on May 4 at the European Stroke Organisation Conference (ESOC) 2022, held in Lyon, France.
"The aim of this trial was to answer the question of whether we can replace alteplase with tenecteplase for all stroke patients receiving thrombolysis in our practice," Menon said. "Our feeling was if we can show noninferiority in a large pragmatic trial then all the other advantages of tenecteplase — single bolus, more cost-effective, potentially faster — you would just change practice."
"The results clearly showed noninferiority of tenecteplase to alteplase for functional outcomes at 90 days, with a trend towards superiority, and safety was similar for the two drugs," Swartz reported.
Asked during discussion after the presentation whether these results should change clinical practice, Menon replied: "The goal of the trial was to change practice, so yes, that is our hope."
