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The ORIGINAL randomized clinical trial compared tenecteplase with alteplase for acute ischemic stroke treated within 4.5 hours of symptom onset. Tenecteplase was given as a single intravenous bolus, whereas alteplase required an infusion. Among nearly 1,500 randomized patients, the proportion achieving an excellent functional outcome at 90 days was numerically higher with tenecteplase, and the prespecified non-inferiority criterion was met. Symptomatic intracerebral haemorrhage and mortality were similar between groups. The results add substantial evidence supporting tenecteplase as an alternative thrombolytic agent in eligible patients. The single-bolus administration may simplify logistics, which is especially relevant in high-volume stroke pathways and systems where treatment speed matters. For HCPs, the trial should be interpreted within current stroke protocols and eligibility criteria. Tenecteplase does not replace the need for rapid imaging, vascular assessment and mechanical thrombectomy when indicated. Its value is as a practical reperfusion option within the appropriate therapeutic window. The evidence is directly relevant to IANCON's focus on acute ischemic stroke, thrombolysis and vascular neurology.
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The ORIGINAL randomized clinical trial compared tenecteplase with alteplase for acute ischemic stroke treated within 4.5 hours of symptom onset. Tenecteplase was given as a single intravenous bolus, whereas alteplase required an infusion. Among nearly 1,500 randomized patients, the proportion achieving an excellent functional outcome at 90 days was numerically higher with tenecteplase, and the prespecified non-inferiority criterion was met. Symptomatic intracerebral haemorrhage and mortality were similar between groups. The results add substantial evidence supporting tenecteplase as an alternative thrombolytic agent in eligible patients. The single-bolus administration may simplify logistics, which is especially relevant in high-volume stroke pathways and systems where treatment speed matters. For HCPs, the trial should be interpreted within current stroke protocols and eligibility criteria. Tenecteplase does not replace the need for rapid imaging, vascular assessment and mechanical thrombectomy when indicated. Its value is as a practical reperfusion option within the appropriate therapeutic window. The evidence is directly relevant to IANCON's focus on acute ischemic stroke, thrombolysis and vascular neurology.
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