Tenecteplase shown to be effective for acute ischaemic stroke in large Canadian study

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In what is claimed to be the largest stroke clinical trial ever run in Canada, researchers have shown that tenecteplase—a safe, well-tolerated drug commonly used as a clot-buster for heart attacks—is an effective treatment for acute ischaemic stroke. They have now published their findings in The Lancet.

Led by researchers with the University of Calgary at the Foothills Medical Centre and Sunnybrook Health Sciences Centre, fully affiliated with the University of Toronto, the study included 1,600 patients at hospitals across the country.

“It is truly an important finding that I share with my colleagues from coast to coast,” said Bijoy Menon (University of Calgary, Calgary, Canada), co-principal investigator on the study. “Through this collaboration, these findings could revolutionise stroke treatment throughout the world. Tenecteplase is known to be an effective clot-dissolving drug. It is very easy to administer, which makes it a gamechanger when seconds count to save brain cells.”

Based on current guidelines, alteplase is the recommended drug for acute ischaemic stroke patients, a University of Calgary press release notes. The challenge, however, is that the drug is more complex to administer. It takes up to an hour and requires an infusion pump that needs to be monitored. The pump can be cumbersome when transporting a patient within a hospital, or to a major stroke centre for treatment.

“One of the reasons tenecteplase is so effective is that it can be administered as a single, immediate dose,” added co-principal investigator Rick Swartz (University of Toronto, Toronto, Canada). “That is a big advantage, saving critical time and complication. Tenecteplase could potentially be administered wherever the patient is seen first, at a medical centre or small hospital.”

The AcT trial compared tenecteplase (0.25mg/kg) to alteplase (0.9mg/kg) in a randomised study. The results published in The Lancet show that tenecteplase worked as well as, if not better than, the current recommended drug. Preliminary findings from AcT were also presented for the first time by Menon and Swartz at the European Stroke Organisation Conference (ESOC 2022; 4–6 May, Lyon, France).

Tenecteplase attaches itself to the clot for a longer period of time than alteplase, which means that blood flow is restored faster and for a longer period of time. Along with discovering a better way to treat acute ischaemic stroke, the team also established a more cost-effective and efficient way to conduct clinical trials, the release notes.


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