Abstract Number: Esoc2026a567 Late-Window Tenecteplase Thrombolysis for Acute Ischemic Stroke in Patients More Than or Equal to 80 Years Old.—a Secondary Analysis of the Trace-Iii Randomized Trial

Abstract Background and aims The risks and benefits of tenecteplase for very old patients with acute ischaemic stroke (AIS) who were treated 4.5 to 24 hours after stroke onset are still unknown. We aimed to investigate the efficacy and safety of tenecteplase for AIS patients aged ≥ 80 years. Methods We performed a post hoc analysis of TRACE-III trial. Patients with anterior large vessel occlusion (LVO) and no access to endovascular thrombectomy were randomized (1:1) to receive either 0.25 mg/kg tenecteplase or standard medical treatment. The primary outcome was modified Rankin scale (mRS) score 0-1 at 90 days. Safety outcomes were symptomatic intracranial haemorrhage (sICH) within 36 hours and all-cause mortality within 90 days. Results Among the 516 patients in the TRACE-III trial, 67 (13.0%) aged ≥ 80 years. The percentage of mRS score of 0 or 1 at 90 days were similar between the tenecteplase and standard treatment groups in patients aged ≥ 80 years (21.4% vs. 10.3%; OR, 2.39; 95% CI, 0.61-9.42) and patients aged 80 years (34.3% vs. 26.8%; OR, 1.43; 95% CI, 0.95-2.15), with a non-significant interaction value of 0.48. The sICH (10.7% vs. 0.0% in aged ≥ 80 years group) and and all-cause mortality (28.6% vs. 20.5% in aged ≥ 80 years group) were similar between the two treatment therapies across age categories. Conclusions In patients with LVO who were not eligible for thrombectomy within 4.5 to 24 hours of onset, tenecteplase was comparable with standard medical treatment for efficacy and safety outcomes in patients aged ≥ 80 years. Conflict of interest All authors have nothing to disclose.