{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:09:43Z","timestamp":1783955383843,"version":"3.55.0"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Tenecteplase is an alternative to alteplase for intravenous thrombolysis in acute ischemic stroke given its simplified administration and comparable safety and efficacy. However, its impact on workflow metrics that may affect clinical outcomes, such as door-to-needle and door-in-door-out times, has not been well-characterized.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare door-to-needle and door-in-door-out times between tenecteplase-treated and alteplase-treated patients with acute ischemic stroke in US hospitals.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used data from the American Heart Association\u2019s Get With The Guidelines-Stroke registry between July 1, 2020, and June 30, 2022. The analysis included adult patients with ischemic stroke who received intravenous thrombolysis. Data analysis was conducted from August to November 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Tenecteplase or alteplase treatment in a consecutive series of patients with ischemic stroke.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were door-to-needle time among patients who arrived directly to the reporting hospital and door-in-door-out time among those transferred after thrombolytic administration. Secondary outcomes were door-to-puncture and other endovascular workflow metrics among patients treated with thrombectomy after thrombolysis. Generalized linear mixed models were used to assess the association between thrombolytic treatment and workflow time intervals outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 133\u202f228 thrombolysis-treated patients (mean [SD] age, 68.3 [14.8] years; 64\u202f173 female [48.2%]; median [IQR] National Institutes of Health Stroke Scale score, 7 [3-14]), 13\u202f988 (10.5%) received tenecteplase, and 119\u202f240 (89.5%) received alteplase. The mean (SD) door-to-needle time was significantly shorter with tenecteplase vs alteplase (47.0 [26.8] vs 52.7 [28.0] minutes; adjusted mean difference, \u22123.13 minutes; 95% CI, \u22123.84 to \u22122.42 minutes). Door-to-needle time 30 minutes or less occurred more frequently with tenecteplase than with alteplase (2955 of 9893 patients [29.9%] vs 14\u202f781 of 72\u202f539 patients [20.4%]; adjusted odds ratio [aOR], 1.34; 95% CI, 1.25 to 1.44), as did door-to-needle time 45 minutes or less (5766 of 9893 patients [58.3%] vs 35\u202f238 of 72\u202f539 patients [48.6%]; aOR, 1.24; 95% CI, 1.17 to 1.32) and 60 minutes or less (7670 of 9893 patients [77.5%] vs 51\u202f282 of 72\u202f539 patients [70.7%]; aOR, 1.25; 95% CI, 1.17 to 1.33). Among transferred patients likely eligible for mechanical thrombectomy, mean (SD) door-in-door-out times were shorter for tenecteplase vs alteplase (108.3 [31.6] vs 114.1 [32.0] minutes; adjusted mean difference, \u22125.94 minutes; 95% CI, \u22129.10 to \u22122.77 minutes). Among patients receiving thrombectomy, shorter times were observed in the tenecteplase group for door-to-arterial puncture, door-to-device deployment, and door-to-reperfusion. Hospitals that transitioned to tenecteplase during the study period had faster door-to-needle time times after vs before the switch (mean [SD], 51.1 [12.1] vs 52.7 [10.8] minutes; adjusted mean difference, \u22121.52 minutes; 95% CI, \u22122.88 to \u22120.15 minutes).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this analysis of a large nationwide registry, tenecteplase was associated with faster door-to-needle and door-in-door-out times than alteplase. These workflow advantages provide support for broader use of tenecteplase for stroke thrombolysis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.23260","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:00:17Z","timestamp":1783954817000},"page":"e2623260","source":"Crossref","is-referenced-by-count":0,"title":["Tenecteplase vs Alteplase and Time to Treatment for Acute Ischemic Stroke"],"prefix":"10.1001","volume":"9","author":[{"given":"Steven J.","family":"Warach","sequence":"first","affiliation":[{"name":"Department of Neurology, Dell Medical School, The University of Texas at Austin and Ascension Texas, Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M.","family":"Weber","sequence":"additional","affiliation":[{"name":"Duke University, Duke Clinical Research Institute, Durham, North 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N.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Mullen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisele Sampaio","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Neurology, Federal University of S\u00e3o Paulo (UNIFESP) and Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Mac Grory","sequence":"additional","affiliation":[{"name":"Department of Neurology and ORBIT Interdisciplinary Hub, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xian","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Texas Southwestern, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Saver","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ronald Reagan-UCLA Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"23","key":"zoi260653r1","doi-asserted-by":"publisher","first-page":"2480","DOI":"10.1001\/jama.2013.6959","article-title":"Time to treatment with intravenous tissue 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