Thrombolysis with tenecteplase compared to alteplase 3-4.5 hours after acute ischemic stroke 
Background. Thrombolysis with alteplase has beneficial effect on outcome and is safe within 4.5 hours (h), but the effect diminishes with increasing time from stroke onset to start of treatment. Tenecteplase is a thrombolytic agent with a potentially better thrombolytic profile than alteplase. In this study, the aim was to compare the efficacy and safety of tenecteplase and alteplase in patients treated 3-4.5 h after ischemic stroke.
Methods. The data are from a prespecified substudy of patients included in The Norwegian Tenecteplase Stroke Trial  (NOR-TEST) which was a multicenter randomized controlled trial conducted in 13 stroke units in Norway..  
Results. In the intention-to-treat analysis 60 (57%) of 105 patients that received tenecteplase and 47 (53%) of 89 patients in the alteplase group reached good functional outcome (mRS 0-1) at three months (OR 1.19, 95% CI 0.68-2.10). The rates of intracranial haemorrhage in the first 48 hours were 5.7% in the tenecteplase group and 6.7% in the alteplase group (OR 0.84, 95% CI 0.26-2.70). At 3 months, mortality was 5.7% (6 of 105) and 4.5% (4 of 89). After excluding stroke mimics and patients with mRS > 1 before stroke, 71 patients remained in the tenecteplase group and 56 patients in the alteplase group. The proportion of patients with good functional outcome was 61% in the tenecteplase group and 57% in the alteplase group (OR 1.24, 95 % CI 0.65-2.37).
Conclusion. Tenecteplase is at least as effective as alteplase to achieve good clinical outcome in patients treated between 3 and 4.5 h after ischemic stroke. The study does not provide reliable data on safety due to low power, and a large number of patients with mild strokes.

THROMBOLYSIS WITH TENECTEPLASE COMPARED TO ALTEPLASE 3-4.5 HOURS AFTER ACUTE ISCHEMIC STROKE