Tenecteplase or Alteplase for Stroke

(ACT-REACT Trial)

This trial examines two treatments for individuals who have experienced an acute ischemic stroke (AIS). The primary goal is to determine if tenecteplase or alteplase, both clot-busting drugs, administered after a procedure called EVT, improves recovery more effectively than standard care alone. Participants will receive one of these treatments or just standard care and will be monitored for 90 days to assess their recovery. Individuals recently diagnosed with a stroke may be suitable candidates for this trial. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants an opportunity to contribute to potentially groundbreaking treatment advancements.

Research has shown that both tenecteplase and alteplase have been studied for their safety in treating strokes caused by blocked blood flow to the brain. Tenecteplase has shown promising results, with studies reporting a lower chance of serious brain bleeding compared to other treatments. It is generally safe and well-tolerated, with less bleeding outside the brain compared to alteplase.

Alteplase is effective but can cause significant bleeding inside or outside the body, especially at needle sites. Some studies suggest a higher chance of brain bleeding compared to a placebo (a harmless pill used for comparison). However, these studies did not show an increased risk of death.

Researchers are excited about tenecteplase and alteplase for stroke treatment because they offer a unique approach through local intra-arterial (IA) thrombolysis. Unlike standard intravenous thrombolysis, IA delivery targets the clot directly, which might increase effectiveness and reduce potential side effects. Tenecteplase, in particular, stands out due to its longer half-life and more targeted action compared to alteplase, potentially allowing for a more efficient clot breakdown and a quicker recovery.

This trial will compare the effectiveness of tenecteplase and alteplase in treating strokes. Research has shown that tenecteplase may effectively treat sudden strokes caused by blocked blood flow to the brain. Approximately 40.5% of patients who received tenecteplase experienced excellent recovery, with little to no disability. Studies have also found that tenecteplase is as safe as alteplase and might even lead to better recovery without increasing the risk of brain bleeding.