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The ATTEST-2 randomized trial compared tenecteplase 0.25 mg/kg with standard-dose alteplase in adults eligible for intravenous thrombolysis within 4.5 hours of acute ischemic stroke onset. The study used a pragmatic multicentre design with masked endpoint assessment and focused on the distribution of modified Rankin Scale scores at 90 days. The findings supported tenecteplase as at least a non-inferior alternative to alteplase, adding to the growing evidence that a single-bolus fibrinolytic can perform comparably to an infusion-based regimen. This matters operationally because streamlined administration can potentially reduce treatment delays, especially in stroke systems that need to move rapidly from imaging to reperfusion. For HCPs, tenecteplase should be considered within established eligibility and dosing frameworks rather than as a universal replacement regardless of setting. The study contributes to an evolving body of evidence supporting tenecteplase across different stroke populations. Together with other randomized trials, it strengthens the scientific basis for revisiting thrombolysis protocols while keeping patient selection and haemorrhagic risk assessment central.
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The ATTEST-2 randomized trial compared tenecteplase 0.25 mg/kg with standard-dose alteplase in adults eligible for intravenous thrombolysis within 4.5 hours of acute ischemic stroke onset. The study used a pragmatic multicentre design with masked endpoint assessment and focused on the distribution of modified Rankin Scale scores at 90 days. The findings supported tenecteplase as at least a non-inferior alternative to alteplase, adding to the growing evidence that a single-bolus fibrinolytic can perform comparably to an infusion-based regimen. This matters operationally because streamlined administration can potentially reduce treatment delays, especially in stroke systems that need to move rapidly from imaging to reperfusion. For HCPs, tenecteplase should be considered within established eligibility and dosing frameworks rather than as a universal replacement regardless of setting. The study contributes to an evolving body of evidence supporting tenecteplase across different stroke populations. Together with other randomized trials, it strengthens the scientific basis for revisiting thrombolysis protocols while keeping patient selection and haemorrhagic risk assessment central.
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