Study Examines Effects of Tenecteplase Following Reperfusion for Stroke

Treatment with intra-arterial TNKase (tenecteplase; Genentech, South San Francisco, CA) after successful endovascular thrombectomy (EVT) for people with acute ischemic stroke (AIS) due to large vessel occlusion did not significantly increase the likelihood of freedom from disability. The results of a clinical trial conducted in China (ChiCTR2200064809), published in JAMA Neurology, also show that the group of participants who received intra-arterial TNKase had a significantly higher rate of intracranial hemorrhage compared with the control group.

The POST-TNK clinical trial was conducted at 34 sites in China. The study included a total of 540 participants with AIS due to proximal intracranial large vessel occlusion within 24 hours of symptom onset who, following EVT, had an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 2c to 3 (90% to 100% microcirculatory reperfusion). Participants were randomized 1:1 to receive either inter-arterial TNKase .0625 mg/kg (maximum dose, 6.25 mg) or no adjunctive intra-arterial thrombolysis. The primary endpoint was freedom from disability, defined as a modified Rankin Scale (mRS) score of 0 or 1 at 90 days after randomization.

Key findings from the study include the following:

• 49.1% of patients in the TNKase group reached the primary endpoint compared with 44.1% in the control group (adjusted risk ratio, 1.15; 95% CI, 0.97 to 1.36; P=.11).
• 90-day mortality rates were 16.0% in the TNKase group and 19.3% in the control group (adjusted hazard ratio, 0.75; 95% CI, 0.50 to 1.13; P=.16).
• Symptomatic intracranial hemorrhage occurred in 6.3% of TNKase-treated participants vs 4.4% of participants in the control group (adjusted risk ratio, 1.43; 95% CI, 0.68 to 2.99; P=.35).

While the results demonstrate a trend towards improved outcomes with adjunctive intra-arterial TNKase, the differences did not achieve statistical significance.