{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:07:24Z","timestamp":1793210844077,"version":"4.5.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Intravenous thrombolysis with tenecteplase within 4.5\u2009h after ischemic stroke is noninferior to alteplase. However, it is uncertain whether this is also true in patients last known to be well more than 4.5\u2009h before treatment initiation (last known to be well more than 4.5\u2009h before treatment initiation (LKW\u2009&gt;\u20094.5\u2009h)). We aimed to compare tenecteplase and alteplase in this population using data from two large multicenter registries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Pooled retrospective analysis of acute stroke patients LKW\u2009&gt;\u20094.5\u2009h treated with tenecteplase 0.25\u2009mg\/kg (Tenecteplase Treatment in Ischemic Stroke Registry (TETRIS) registry) or alteplase 0.9\u2009mg\/kg (EVATRISP registry plus 4 French centers participating in TETRIS) based on the results of magnetic resonance imaging (MRI) or perfusion computed tomography (CT). Excellent functional outcome at 3\u2009months (modified Rankin Scale (mRS) 0\u20131) was the primary outcome. Secondary outcomes were mRS 0\u20132, shift analysis of the mRS, any intracranial hemorrhage (ICH), symptomatic ICH, and death. Propensity-score overlap weighting (PSOW) was used to account for imbalance in baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 897 patients (tenecteplase: n\u2009=\u2009419; alteplase: n\u2009=\u2009478) were included between 2015 and 2024 (mean age: 74 (IQR 64\u201384); median National Institutes of Health Stroke Scale 11 (6\u201317) unknown stroke onset in 777 (86.6%) patients). At 3\u2009months, mRS 0\u20131 was achieved in 138 (32.9%) and 178 (37.2%) patients treated with tenecteplase and alteplase, respectively (crude OR 0.83 (95% confidence interval (CI) 0.63\u20131.09); PSOW-OR 0.92 (95% CI 0.66\u20131.30)). Compared with alteplase, tenecteplase was not significantly associated with mRS 0\u20132 (PSOW-OR 0.78 (95% CI 0.56\u20131.08)) or better functional outcome over the whole range of the mRS (PSOW-common OR 0.83 (95% CI 0.62\u20131.11)). Tenecteplase was associated with significantly higher odds of any ICH (PSOW-OR: 1.79 (95% CI 1.25\u20132.57)), but not symptomatic intracranial hemorrhage (PSOW-OR 1.12 (95% CI 0.61\u20132.05)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The functional outcomes of patients LKW\u2009&gt;\u20094.5\u2009h treated with tenecteplase or alteplase did not significantly differ in this pooled analysis of two observational registries. However, the direction of the associations did not favor tenecteplase over alteplase, and therefore, more comparative studies\u2014ideally randomized\u2014are needed before routinely switching to tenecteplase in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930251385744","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T03:51:32Z","timestamp":1759204292000},"page":"667-675","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Tenecteplase or alteplase for acute ischemic stroke beyond 4.5 hours of last known well: A pooled analysis of the TETRIS and EVATRISP registries"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3366-559X","authenticated-orcid":false,"given":"Cl\u00e9mence","family":"Liegeois","sequence":"first","affiliation":[{"name":"Neurologie Department, GHU Paris Psychiatrie et Neurosciences, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerian","family":"Altersberger","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Neurology, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland"},{"name":"Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2456-704X","authenticated-orcid":false,"given":"Gaspard","family":"Gerschenfeld","sequence":"additional","affiliation":[{"name":"Urgences C\u00e9r\u00e9bro-Vasculaires, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, AP-HP, H\u00f4pital Saint-Antoine, Sorbonne Universit\u00e9, Paris, France"},{"name":"Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Paris, France"},{"name":"Sorbonne Universit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6710-8153","authenticated-orcid":false,"given":"St\u00e9phane","family":"Olindo","sequence":"additional","affiliation":[{"name":"Neurologie, CHU de Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8494-5527","authenticated-orcid":false,"given":"Alexander","family":"Salerno","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam R","family":"Heldner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Martinez-Majander","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Gensicke","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Neurology, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland"},{"name":"Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Forlivesi","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[{"name":"University Teaching and Research Hospital, HOCH-Kantonsspital St. Gallen, Gallen, Switzerland"},{"name":"Medical Faculty, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Chausson","sequence":"additional","affiliation":[{"name":"Unit\u00e9 Neuro-vasculaire, H\u00f4pital Sud Francilien, Corbeil-Essonnes, France"},{"name":"Universit\u00e9 Paris Saclay, Gif-sur-Yvette, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Cimflova","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Pico","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, Mignot Hospital, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2134-0691","authenticated-orcid":false,"given":"Pierre","family":"Seners","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Paris, France"},{"name":"Neurology Department, H\u00f4pital Fondation A. de Rothschild, Paris, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyoon","family":"Baik","sequence":"additional","affiliation":[{"name":"Neurologie Department, GHU Paris Psychiatrie et Neurosciences, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Hobeanu","sequence":"additional","affiliation":[{"name":"Neurology Department, H\u00f4pital Fondation A. de Rothschild, Paris, 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