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An In-depth Exploration of Tenecteplase in Stroke and Its Long-term Follow-up: A Singular Endeavor within the Heartland of Tamil Nadu

Vedhanayagam N,Asokan K,S. S

Published 2025 in Journal of Stroke Medicine

ABSTRACT

Background Stroke presents with variable clinical profiles across different geographical locations. Therefore, studying stroke and conducting long-term follow-ups in specific subpopulations will guide us in the initiation of better treatment and preventive measures. Aim To assess tenecteplase’s safety and effectiveness, as well as the clinical characteristics and long-term monitoring of stroke patients in Coimbatore. Methods One hundred individuals with acute ischemic stroke who received tenecteplase within a 4.5-h timeframe were included in this prospective research. The period of these patients’ admissions was August 2018-February 2022. Following patient consent and ethical committee permission, we examined the patients’ clinical characteristics, tenecteplase safety profile, primary and secondary outcomes, and long-term follow-up for a maximum of 18 months. Results The mean age of the 100 patients was 58.9 years, with 71 being men and 29 being women. Fourteen of the patients were younger than 45. The TOAST categorization showed that 34 had lacunar strokes, 14 had cardioembolic strokes, and 55 had massive infarcts. Regardless of their vegetarianism or alcohol consumption, 48 individuals showed either hyperhomocysteinemia or a B12 deficiency. The middle cerebral artery (MCA) was the source of 75 of the 87 anterior circulation strokes and 13 posterior circulation strokes that were found. The average door-to-needle duration was 75.7 min, and the average time of stroke onset (TSO) was 2.7 h. The immediate National Institutes of Health Stroke Scale (NIHSS) score following tenecteplase injection (within 1 h) was 7.6, while the mean NIHSS score at admission was 9.56. Two patients suffered intracerebral hemorrhage, whereas 47% of patients obtained the primary endpoint, and 67% reached the secondary outcome. Recurrent vascular events, such as myocardial infarction (7), peripheral vascular disease (3), recurrent stroke (10), and mortality (16), occurred in 36 patients during the 18-month follow-up. Conclusion Within the 4.5-h window, tenecteplase is a safe and efficient thrombolytic treatment for acute ischemic stroke. In contrast to earlier stroke studies conducted in India, the mean age of presentation in our study was 58.9 years. Therefore, our society should implement basic preventive measures that are effective and based on the population. B12 deficiency and hyperhomocysteinemia are significant vascular risk factors for macrovascular events that require appropriate screening and management. Recurrent macrovascular events, including mortality, occurred in 36% of patients during their follow-up, which is a greater rate even with secondary preventive interventions. This emphasizes how our community has to implement strong primary and secondary prevention measures.

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