Abstract TMP24: Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST 2)

Background: IV thrombolysis with alteplase, the only medical treatment currently approved for acute ischaemic stroke, significantly increases the probability of excellent recovery. A recent trial has demonstrated that the modified tissue plasminogen activator tenecteplase at a dose of 0.4mg/kg is of similar safety and efficacy to alteplase in acute stroke. In addition to having simpler administration, tenecteplase 0.25mg/kg is also potentially superior to alteplase with respect to efficacy, based on meta-analysis of small trials. More data are required to establish the true risk-benefit profile compared with alteplase. Objectives & Methods: ATTEST-2 will establish whether tenecteplase is superior to alteplase by undertaking a prospective randomised open blinded end-point (PROBE) trial in patients eligible for IV thrombolysis based on non-contrast CT imaging. The study opened to recruitment in Dec 2016. 60 UK centres will recruit 1870 patients. Outcome: Primary outcome is the distribution of modified Rankin Scale (mRS) outcomes at day 90, determined by the Rankin Focused Assessment method, analysed by ordinal distribution ("shift") analysis of the of scores in intervention and control groups. Conclusion: An agent with superior risk:benefit ratio to alteplase would potentially extend thrombolytic treatment a greater proportion of patients than at present and reduce the need for mechanical thrombectomy. This trial will contribute to the optimisation of reperfusion strategies.