The comparison of short-term outcome between tenecteplase and alteplase in minor acute ischemic stroke based on neutrophil-to-lymphocyte ratio stratification

This study aims to compare the effects of intravenous thrombolysis (IVT) with alteplase versus tenecteplase (TNK) on short-term outcomes in patients with minor acute ischemic stroke (AIS) across different levels of neutrophil-to-lymphocyte ratio (NLR). Patients with minor AIS (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5) who underwent IVT were prospectively and consecutively enrolled. A total of 234 participants were included, among whom 86 (36.8%) received alteplase while 148 (63.2%) received TNK.

At discharge, 158 (67.5%) patients achieved an excellent outcome [a modified Rankin Scale (mRS) of 0–1 point]. Using the median NLR value of 2.34 (1.64, 3.89), participants were stratified into a low-NLR group (NLR ≤ 2.34) and a high-NLR group (NLR > 2.34). In the low-NLR group, IVT with TNK was associated with an excellent outcome (OR = 3.44, 95% CI: 1.25–9.47, p = 0.017) but was not associated with an excellent outcome (OR = 1.93, 95% CI: 0.80–4.69, p = 0.14) in the high-NLR group.

For patients with minor AIS within 4.5 h of onset, TNK may be considered a preferred option for IVT In the low-NLR subgroup. This study was supported by grants from the Ma’anshan Science and Technology Planning Project (No. Department of Neurology, Ma’anshan People’s Hospital, No. 45 Hubei Road, Ma’anshan City, Anhui Province, China Liangxu Xiang, Jing Xu, Zhaohai Feng, Zhide Li, Yingwei Zheng, Yunyun Li, Pingping Zhu, Lu Liu & Meiying Li The authors declare no competing interests.

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Xiang, L., Xu, J., Feng, Z. et al. The comparison of short-term outcome between tenecteplase and alteplase in minor acute ischemic stroke based on neutrophil-to-lymphocyte ratio stratification. Sci Rep (2026). https://doi.org/10.1038/s41598-026-74273-1 DOI: https://doi.org/10.1038/s41598-026-74273-1