Background: Older age has been associated with overall poorer outcomes in acute ischemic stroke. We compared (1) outcomes in various health-related domains among patients <80 years and ≥80 presenting with acute ischemic stroke (2) whether outcomes differ between intravenous tnk (tenecteplase) versus alteplase.

Methods: Data are from patients included in AcT (Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke), a pragmatic, registry-linked, phase 3 randomized controlled trial comparing TNK with alteplase. Outcomes included functional disability (per 90-day modified Rankin Scale), safety (24-hour symptomatic intracerebral hemorrhage, 90-day mortality rates), health care utilization (discharge destination, length of stay, thrombectomy rate), and quality of life measures (EQ-5D-5L [EuroQol 5-Dimension 5-Level Scale]). With an a priori plan, patients aged <80 years were compared with those ≥80 at symptom onset. mixed effects poisson regression was used to assess (1) the association of age outcomes and (2) if these associations modified by thrombolytic administered (tnk versus alteplase), after adjusting for sex, baseline stroke severity.

Results: Of the 1577 patients, 1034 (65.6%; 520: TNK and 514: alteplase) were <80 years and 543 (34.4%; 286: tnk 257: alteplase) were ≥80 of age. baseline characteristics in the 2 groups similar except for sex 40% female <80 group versus 62.8% years. there was no difference rates symptomatic intracranial hemorrhage (3.5% 3.1%). patients had significantly lower excellent functional outcome, return to status, higher mortality, quality-of-life outcomes as compared with group. length hospital stay between but, age endovascular treatment utilization. type thrombolytic agent (tnk did not modify association primary clinical outcome (p(interaction) =0.22).

Conclusions: Similar to alteplase, increasing age was associated with poorer functional outcomes with TNK. Rates of angiographic and bleeding outcomes were similar between patients <80 and ≥80 years. registration: url: https:>