Abstract TP3: Safety of Tenecteplase in Stroke Mimic

Introduction: Thrombolysis is the gold standard of treatment for acute ischemic stroke, but it must be administered within a narrow time window. This urgency requires healthcare providers to make swift treatment decisions, even when other diagnoses might explain stroke-like symptoms. While treatment with alteplase has been shown to be safe in stroke mimics, the safety of tenecteplase (TNK) in stroke mimics remains unknown. Therefore, our objective was to evaluate the safety of TNK in patients with stroke-like symptoms with and without a confirmed stroke diagnosis. Methods: This was a retrospective cohort study comparing those with acute ischemic stroke (AIS), defined as an ischemic stroke diagnosis on discharge, and those with a stroke mimic, those without an ischemic stroke diagnosis on discharge. Consecutive patients admitted between June 1, 2020, and June 30, 2023, were screened for inclusion in the study. Those patients less than 18 years old, without neuroimaging within 24 hours of TNK administration, who received TNK for an indication other than acute ischemic stroke, and who received mechanical thrombectomy were excluded from the trial. The primary outcome was symptomatic intracranial hemorrhage as defined by the ECAS III criteria. Secondary outcomes included major systemic hemorrhage, minor systemic hemorrhage, asymptomatic intracranial hemorrhage, length of stay, angioedema, and discharge disposition. Results: A total of 250 patients were included in the study. Of those 174 were in the AIS group and 76 in the stroke mimic group. Those in the AIS group were older (69 [13.8] vs. 62.3 [16.1]; p=0.0008), but otherwise were similar with regards to baseline demographics. There was no statistical difference in symptomatic intracranial hemorrhage when comparing the AIS and mimic groups (5 [2.9%] vs. 0 [0%]; p=0.3267); however, there was a statistically higher proportion of patients who experienced an asymptomatic intracranial hemorrhage in the AIS group (15 [8.6%] vs. 0 (0%); p=0.0067). In addition, those in the AIS group had a longer median length of stay as compared to the mimic group (3 days [2 days, 6 days] vs. 2 days [2 days, 4 days]; p=0.0018). There were no statistical differences in major systemic hemorrhage, minor systemic hemorrhage, angioedema, or discharge disposition. Conclusion: The use of TNK in patients with a stroke mimic did not result in a statistically higher proportion of patients who experienced a symptomatic intracranial hemorrhage.