Oral Presentation Asia Pacific Stroke Conference 2024

Impact of body mass index on the efficacy and safety of tenecteplase versus alteplase in acute ischemic stroke patients (111687)

Shuhong Xu 1 , Huihui Liu 2 3 4 , Runqi Wangqin 5 , Mengxing Wang 4 , Aoming Jin 4 , Yuesong Pan 2 4 , Qianmei Jiang 2 , Xia Meng 2 4 , Hao Li 2 4 , Zixiao Li 2 4 6 , Yongjun Wang 2 4 5 7 8 , Shuya Li 2 4
  1. Capital Medical University, China
  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. Department of Neurology and Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow University, Suzhou, China
  4. China National Clinical Research Center for Neurological Diseases, Beijing, China
  5. Advanced Innovation Center for Human Brain Protection, Capital Medical University, China
  6. Chinese Institute for Brain Research, China
  7. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, China
  8. Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, China

The impact of body mass index (BMI) on the benefit and safety profiles of tenecteplase versus alteplase in acute ischemic stroke (AIS) patients remains unclear. This study aimed to evaluate the efficacy and safety of tenecteplase compared to alteplase for AIS patients undergoing intravenous thrombolysis (IVT) across different BMI categories.

This subgroup analysis was derived from the TRACE-2 (Tenecteplase Reperfusion Therapy in Acute Ischemic Cerebrovascular Events-2) trial. AIS patients eligible for IVT but ineligible for endovascular thrombectomy were enrolled and randomly assigned to receive either intravenous tenecteplase (0.25 mg/kg) or alteplase (0.9 mg/kg). Patients were classified into underweight (BMI<18.5 kg/m2), normal weight (18.5≤ BMI<23 Kg/m2), overweight (23≤BMI<25 kg/m2), and obese (≥25 kg/m2). The primary efficacy and safety outcome were the proportion of patients achieving a modified Rankin Scale (mRS) score of 0–1 at 90 days and symptomatic intracranial hemorrhage (sICH) within 36 hours, respectively.

Among 1392 patients, 73 (5%) were underweight, 482 (35%) normal weight, 299 (21%) overweight, and 538 (39%) obese. There was no significant difference in the primary efficacy outcome between tenecteplase and alteplase among normal weight, overweight, and obese patients (P=0.15, 0.91, and 0.95, respectively). However, in the underweight group, tenecteplase was associated with a higher proportion of primary efficacy outcome compared to alteplase (25 (65.8%) vs. 10 (30.3%); RR=2.17, 95% CI 1.23 to 3.82, P=0.003). A significant interaction was observed between thrombolytic treatments and BMI categories (P=0.04). No significant difference was noted in the primary safety outcome between tenecteplase and alteplase treatments across all BMI categories.