ArticleFrontiers in neurology
Imaging patterns of hemorrhagic transformation after tenecteplase versus alteplase in real-world practice.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: While randomized trials have demonstrated noninferiority of tenecteplase compared with alteplase in terms of functional outcomes and symptomatic intracranial hemorrhage (sICH), differences in hemorrhagic imaging phenotypes remain insufficiently explored in real-world practice. Methods: We conducted a retrospective real-world cohort study of consecutive patients with acute ischemic stroke treated with intravenous thrombolysis between January and December 2025. The primary endpoint was ordinal shift in hemorrhagic transformation severity according to the Heidelberg Bleeding Classification (HBC). Secondary endpoints included sICH. Multivariable logistic regression was performed to identify independent predictors of hemorrhage. Results: A total of 95 patients were included (alteplase Conclusion: In this small exploratory real-world cohort, tenecteplase was not associated with an obvious increase in hemorrhagic events compared with alteplase. However, because of the limited sample size and small number of severe hemorrhagic events, these findings should be interpreted as preliminary and hypothesis-generating. Imaging-based classification using the Heidelberg framework did not reveal a significant shift toward more severe hemorrhagic phenotypes.
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