PT - JOURNAL ARTICLE AU - Nair, Radhika AU - Singh, Nishita AU - Kate, Mahesh AU - Asdaghi, Negar AU - Sarmiento, Robert AU - Bala, Fouzi AU - Coutts, Shelagh B AU - Horn, MacKenzie AU - Poppe, Alexandre Y AU - Williams, Heather AU - Ademola, Ayoola AU - Alhabli, Ibrahim AU - Benali, Faysal AU - Khosravani, Houman AU - Hunter, Gary AU - Tkach, Aleksander AU - Manosalva Alzate, Herbert Alejandro AU - Pikula, Aleksandra AU - Field, Thalia AU - Trivedi, Anurag AU - Dowlatshahi, Dar AU - Catanese, Luciana AU - Shuaib, Ashfaq AU - Demchuk, Andrew AU - Sajobi, Tolulope AU - Almekhlafi, Mohammed A AU - Swartz, Richard H AU - Menon, Bijoy AU - Buck, Brian H TI - Intravenous tenecteplase compared with alteplase for minor ischaemic stroke: a secondary analysis of the AcT randomised clinical trial AID - 10.1136/svn-2023-002828 DP - 2024 Dec 01 TA - Stroke and Vascular Neurology PG - 604--612 VI - 9 IP - 6 4099 - http://svn.bmj.com/content/9/6/604.short 4100 - http://svn.bmj.com/content/9/6/604.full SO - Stroke Vasc Neurol2024 Dec 01; 9 AB - Background In ischaemic stroke, minor deficits (National Institutes of Health Stroke Scale (NIHSS) ≤5) at presentation are common but often progress, leaving patients with significant disability. We compared the efficacy and safety of intravenous thrombolysis with tenecteplase versus alteplase in patients who had a minor stroke enrolled in the Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke (AcT) trial.Methods The AcT trial included individuals with ischaemic stroke, aged >18 years, who were eligible for standard-of-care intravenous thrombolysis. Participants were randomly assigned 1:1 to intravenous tenecteplase (0.25 mg/kg) or alteplase (0.9 mg/kg). Patients with minor deficits pre-thrombolysis were included in this post-hoc exploratory analysis. The primary efficacy outcome was the proportion of patients with a modified Rankin Score (mRS) of 0–1 at 90–120 days. Safety outcomes included mortality and symptomatic intracranial haemorrhage (sICH).Results Of the 378 patients enrolled in AcT with an NIHSS of ≤5, the median age was 71 years, 39.7% were women; 194 (51.3%) received tenecteplase and 184 (48.7%) alteplase. The primary outcome (mRS score 0–1) occurred in 100 participants (51.8%) in the tenecteplase group and 86 (47.5 %) in the alteplase group (adjusted risk ratio (RR) 1.14 (95% CI 0.92 to 1.40)). There were no significant differences in the rates of sICH (2.9% in tenecteplase vs 3.3% in alteplase group, unadjusted RR 0.79 (0.24 to 2.54)) and death within 90 days (5.5% in tenecteplase vs 11% in alteplase group, adjusted HR 0.99 (95% CI 0.96 to 1.02)).Conclusion In this post-hoc analysis of patients with minor stroke enrolled in the AcT trial, safety and efficacy outcomes with tenecteplase 0.25 mg/kg were not different from alteplase 0.9 mg/kg.Data are available upon reasonable request. Data collected for the study, including de-identified individual participant data and a data dictionary defining each field in the set, can be made available to others upon reasonable request and after signing appropriate data sharing agreements by contacting the corresponding author. Such requests must be approved by the respective ethics boards and appropriate data custodians.