Tenecteplase versus alteplase for acute stroke within 4.5h of onset: the second alteplase-tenecteplase trial evaluation for stroke thrombolysis (ATTEST-2)

The results of a major stroke trial presented at the World Stroke Congress in Toronto today, has demonstrated the potential of a new treatment for stroke which could help patients make a better recovery.

Stroke is a leading cause of death and disability. There are 100,000 strokes each year, and 1.3 million stroke survivors in the UK. For every minute left untreated 1.9 million brain cells die.

Thrombolysis (using alteplase) has revolutionised stroke treatment since the mid-1990s. It has the ability to break up blood clots to restore blood flow to the brain and limit the damage, which may otherwise be caused.

In this trial, tenectaplase, a thrombolytic drug, was administered as a single shot. The current drug licensed for use, alteplase, must be administered gradually over time. Single administration treatment would be a preferable treatment, as it easier to administer; saves clinical teams time and makes it easier to move patients for further treatment.

Between 2017 and 2023, 40 hospitals recruited 1858 participants. Following exclusions, 885 were treated with tenecteplase and 891 with alteplase.

This research showed tenectaplase to have greater benefits than current treatment for stroke patients. Dr Richard Francis, Head of Research at the Stroke Association said:

“We’re delighted to have jointly funded this important clinical trial which today shows that tenecteplase is at least as effective as the currently administered thrombolytic drug – alteplase and has other significant benefits.

“Being able to administer thrombolysis in one single shot is important for saving time for patients who may need to move between hospitals for specialist stroke treatment including thrombectomy. Time is everything when it comes to treating stroke. Specialist care is vital too. We’re pleased to see a drug which is better able to do this, improving patient outcomes.

“The potential of tenecteplase as a better treatment option for stroke is a real opportunity for stroke services and could reduce the burden of disability for stroke survivors in the future. A trial of this size demonstrating such positive results, we hope will bring this drug closer to routine clinical practice for stroke care.”