{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:59:56Z","timestamp":1790312396975,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Tenecteplase can be given as a single bolus, but comparative estimates from routine stroke care are susceptible to treatment-selection bias. Methods: We reviewed 269 adults treated at one center with intravenous tenecteplase (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f110) or alteplase (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f159) within 4.5\u202fh of symptom onset from March 2024 through March 2026. The primary outcome was functional independence at 90\u202fdays [modified Rankin Scale (mRS) 0\u20132]. A logistic propensity-score model included pretreatment clinical and laboratory variables. Stabilized average-treatment-effect weights were truncated at the 1st and 99th percentiles. We report weighted risks, risk differences (RDs), odds ratios (ORs), and robust 95% confidence intervals (CIs). Secondary neurological\/workflow and safety outcomes were adjusted within separate families using the Holm procedure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After weighting, 90-day functional independence was 77.9% with tenecteplase and 81.3% with alteplase (RD, \u22123.5 percentage points; 95% CI, \u221217.0 to 10.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.616; OR, 0.81; 95% CI, 0.36\u20131.82). Holm-adjusted\n                      <jats:italic>p<\/jats:italic>\n                      values for the other functional outcomes were 1.000. The weighted mean difference in door-to-needle time was \u22125.0\u202fmin (95% CI, \u22129.0 to \u22120.9; unadjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.017; Holm-adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.068). Day-7 early neurological deterioration occurred in no tenecteplase recipient and nine alteplase recipients (weighted RD, \u22125.1 percentage points; 95% CI, \u22128.5 to \u22121.7; Holm-adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.016). SITS-MOST symptomatic intracranial hemorrhage occurred in four patients, with a weighted RD of 0.2 percentage points (95% CI, \u22121.7 to 2.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tenecteplase was not associated with greater 90-day functional independence in this propensity-weighted cohort. No clear between-group difference was observed in major hemorrhagic outcomes. DNT was shorter before multiplicity adjustment, and day-7 deterioration was less frequent after adjustment within the secondary neurological\/workflow family.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1928004","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:05Z","timestamp":1790310425000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tenecteplase versus alteplase for intravenous thrombolysis in acute ischemic stroke: a single-center propensity-weighted cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jin","family":"Ma","sequence":"first","affiliation":[{"name":"The Seventh Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heyireguli","family":"Wulayimu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Ma","sequence":"additional","affiliation":[{"name":"The Seventh Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2396987321989865","article-title":"European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke","volume":"6","author":"Berge","year":"2021","journal-title":"Eur Stroke J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1177\/23969873221150022","article-title":"European stroke organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke","volume":"8","author":"Alamowitch","year":"2023","journal-title":"Eur Stroke J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/S0140-6736(22)01054-6","article-title":"Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial","volume":"400","author":"Menon","year":"2022","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/S0140-6736(22)02600-9","article-title":"Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial","volume":"401","author":"Wang","year":"2023","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1001\/jama.2024.14721","article-title":"Tenecteplase vs alteplase for patients with acute ischemic stroke: the ORIGINAL randomized clinical trial","volume":"332","author":"Meng","year":"2024","journal-title":"JAMA"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1016\/S1474-4422(24)00377-6","article-title":"Tenecteplase versus alteplase for acute stroke within 4.5 h of onset (ATTEST-2): a randomised, parallel group, open-label trial","volume":"23","author":"Muir","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/S1474-4422(24)00206-0","article-title":"Tenecteplase versus alteplase for thrombolysis in patients selected by use of perfusion imaging within 4.5 h of onset of ischaemic stroke (TASTE): a multicentre, randomised, controlled, phase 3 non-inferiority trial","volume":"23","author":"Parsons","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e209903","DOI":"10.1212\/WNL.0000000000209903","article-title":"Tenecteplase vs alteplase in acute ischemic stroke within 4.5 hours: a systematic review and meta-analysis of randomized trials","volume":"103","author":"Palaiodimou","year":"2024","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1001\/jamaneurol.2023.1449","article-title":"Symptomatic intracranial hemorrhage with tenecteplase vs alteplase in patients with acute ischemic stroke","volume":"80","author":"Warach","year":"2023","journal-title":"JAMA Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"Von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1161\/01.STR.20.7.864","article-title":"Measurements of acute cerebral infarction: a clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/S0140-6736(07)60149-4","article-title":"Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study","volume":"369","author":"Wahlgren","year":"2007","journal-title":"Lancet"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2243","DOI":"10.1161\/01.STR.0000027437.22450.BD","article-title":"Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin scale","volume":"33","author":"Wilson","year":"2002","journal-title":"Stroke"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.4081\/ni.2013.e2","article-title":"Reliability of the modified Rankin scale applied by telephone","volume":"5","author":"Savio","year":"2013","journal-title":"Neurol Int"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin","year":"2015","journal-title":"Stat Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2672","DOI":"10.1002\/sim.10078","article-title":"On variance estimation of the inverse probability-of-treatment weighting estimator: a tutorial for different types of propensity score weights","volume":"43","author":"Kostouraki","year":"2024","journal-title":"Stat Med"},{"key":"ref18","first-page":"65","article-title":"A simple sequentially rejective multiple test procedure","volume":"6","author":"Holm","year":"1979","journal-title":"Scand J Stat"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1080\/01621459.2016.1260466","article-title":"Balancing covariates via propensity score weighting","volume":"113","author":"Li","year":"2018","journal-title":"J Am Stat Assoc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1161\/STR.0000000000000513","article-title":"2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association\/American Stroke Association","volume":"57","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/S0140-6736(98)08020-9","article-title":"Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II)","volume":"352","author":"Hacke","year":"1998","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"Von Kummer","year":"2015","journal-title":"Stroke"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1928004\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:06Z","timestamp":1790310426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1928004\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":22,"alternative-id":["10.3389\/fneur.2026.1928004"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1928004","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"1928004"}}