Comparing Clinical Characteristics and Outcomes of Tenecteplase Versus Alteplase in Young Adult Patients With Stroke: A Secondary Analysis of the AcT Trial
Year: 2026
Type: article
Abstract: BACKGROUND: With the increasing use of tenecteplase for acute ischemic stroke, it is important to determine its safety in young adults. We aimed to characterize the clinical characteristics and imaging findings of young adults (≤45 years) in the AcT trial (Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada) and to compare their safety and efficacy outcomes. METHODS: This is a secondary analysis of the AcT trial, a phase 3 pragmatic multicenter registry-linked randomized controlled trial. We describe clinical and imaging characteristics of young adults with acute ischemic stroke. Logistic regression adjusted for sex and stroke severity was performed to assess safety and efficacy outcomes between the tenecteplase and alteplase arms. RESULTS: Of the 1577 enrolled patients, 68 (4.31%) were ≤45 years. Of 53 patients with available comorbidity data, 33 (62.26%) had no comorbidities. Hypertension was the most common comorbidity (n=8, 15%), whereas cardiac pathologies were observed in a smaller proportion (n=4, 7.5%). Intracranial atherosclerosis was identified in 7 patients (10%) and carotid or vertebral artery dissection in 6 patients (9%). Safety outcomes, including mortality, intracranial hemorrhage, and serious adverse events, were similar between the tenecteplase and alteplase arms. Excellent functional outcome (modified Rankin Scale score 0-1) at 90 days was better in the tenecteplase arm (84.72% versus 45%; adjusted odds ratio, 6.55 [95% CI, 1.89-22.71]). CONCLUSIONS: The majority of young adults presenting with acute ischemic stroke did not have any traditional risk factors for stroke at presentation. Safety outcomes were similar between the tenecteplase and alteplase arms. Although functional outcomes were observed to be better in the tenecteplase arm, these findings are exploratory and should be interpreted cautiously, given the study's limited sample size and lack of adjustment for key confounders. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
Authors: Katrina Hannah D. Ignacio, Fouzi Bala, Luciana Catanese, Aleksander Tkach, Mahesh Kate, Brian Buck, Ayoola Ademola, Tolulope T. Sajobi, Thalia S. Field, Aleksandra Pikula, Michel Shamy, Gary Hunter, Richard H. Swartz, MacKenzie Horn, Dariush Dowlatshahi, Jai Jai Shankar, Michael D. Hill, Bijoy K. Menon, Mohammed A. Almekhlafi, Nishita Singh
Institutions: University of Calgary, Université de Tours, Centre Hospitalier Universitaire de Tours, Hamilton Health Sciences, McMaster University, Kelowna General Hospital, University of Alberta, University of British Columbia, University of Toronto, Krembil Brain Institute, University of Ottawa, University of Saskatchewan, Sunnybrook Health Science Centre, University of Manitoba
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W7125371684