Incidence and predictors of intracranial hemorrhage after intravenous thrombolysis with tenecteplase

Despite its increasing use, there are limited data on the risk of intracranial hemorrhage (ICH) after intravenous thrombolysis with tenecteplase in the setting of acute ischemic stroke. Our aim was to investigate the incidence and predictors of ICH after tenecteplase administration.

We reviewed data from the prospective ongoing multicenter TETRIS (Tenecteplase Treatment in Ischemic Stroke) registry. Patients with available day-1 imaging were included in this study. Clinical, imaging and biological variables were collected. Follow-up imaging performed 24 h after IVT was locally reviewed by senior neuroradiologists and neurologists. The incidence of parenchymal hematoma (PH) and any ICH were investigated. Potential predictors of PH and any ICH were assessed in multivariable logistic regressions. Subgroup analyses focusing on patients intended for endovascular treatment were performed.

PH and any ICH occurred in 126/1321 (incidence rate: 9.5%, 95% CI 8.1–11.2) and 521/1321 (39.4%, 95% CI 36.8–42.1) patients, respectively. Symptomatic ICH was observed in 77/1321 (5.8%; 95% CI 4.7–7.2). PH occurrence was significantly associated with poorer functional outcomes (p < 0.0001) and death (p < 0.0001) after 3 months. Older age (aOR = 1.03; 95% CI 1.01–1.05), male gender (aOR = 2.07; 95% CI 1.28–3.36), a history of hypertension (aOR = 2.08; 95% CI 1.19–3.62), a higher baseline NIHSS (aOR = 1.07; 95% CI 1.03–1.10) and higher admission blood glucose level (aOR = 1.12; 95% CI 1.05–1.19) were independently associated with PH occurrence. Similar associations were observed in the subgroup of patients intended for endovascular treatment.

We quantified the incidence of ICH after IVT with tenecteplase in a real-life prospective registry and determined independent predictors of ICH. These findings allow to identify patients at high risk of ICH.