TIMELESS: Late-Window Tenecteplase Fails to Improve Stroke Outcomes

This trial informs neurology pharmacists whether adding intravenous tenecteplase to standard care (mostly thrombectomy) benefits perfusion-selected patients presenting 4.5 to 24 hours after stroke onset.

tenecteplasethrombolyticstissue plasminogen activatorischemic strokelarge-vessel occlusionendovascular thrombectomyperfusion imagingTIMELESSrandomized controlled trialneurology Neurology / Neuropharmacology

Background Information

Tenecteplase fails to outperform placebo in delayed stroke treatment.

Exploring tenecteplase for ischemic stroke beyond 4.5 hours could expand treatment options for patients presenting late. Tenecteplase did not improve outcomes compared to placebo when administered 4.5 to 24 hours after stroke onset, with similar mortality and hemorrhage rates. The study showed no clinical benefit of late tenecteplase administration; further research needed for alternative late treatment strategies. Tenecteplase beyond 4.5 hours offers no added benefit in stroke outcomes.

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Authors: Albers GW, Jumaa M, Purdon B, Zaidi SF, Streib C, Shuaib A, Sangha N, Kim M, Froehler MT, Schwartz NE, Clark WM, Kircher CE, Yang M, Massaro L, Lu XY, Rippon GA, Broderick JP, Butcher K, Lansberg MG, Liebeskind DS, Nouh A, Schwamm LH, Campbell BCV, TIMELESS Investigators

Citation: Albers GW, Jumaa M, Purdon B, et al. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. The New England journal of medicine. 2024;390(8):701-711. doi:10.1056/NEJMoa2310392

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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