JAMA

ISC 2026: Tenecteplase shows benefit beyond 4.5 hours in select stroke patients

February 6, 2026

Presented at the International Stroke Conference (ISC) 2026, the OPTION randomized trial (NCT05752916) enrolled 566 patients with non–large vessel occlusion (LVO) ischemic stroke and salvageable brain tissue treated 4.5 to 24 hours after last seen well. Patients receiving IV tenecteplase (0.25 mg/kg) were more likely than those given standard medical therapy to achieve excellent functional outcomes at 90 days (43.6% vs. 34.2%; risk ratio [RR], 1.28; 95% confidence interval [CI], 1.04-1.57; P = 0.02), though symptomatic intracranial hemorrhage occurred more often (2.8% vs. 0%; risk difference, 2.85%; 95% CI, 1.16%-5.54%; P =0 .004). Ninety‑day mortality was 5.0% and 3.2%, respectively (RR, 1.57; 95% CI, 0.69-3.57; P =0 .28).

Clinical takeaway: In carefully selected non‑LVO stroke patients beyond 4.5 hours, late‑window tenecteplase improved functional outcomes but increased bleeding risk.

Source:

Ma G, et al. (2026, February 5). JAMA. Tenecteplase for Acute Non–Large Vessel Occlusion 4.5 to 24 Hours After Ischemic Stroke: The OPTION Randomized Clinical Trial. https://jamanetwork.com/journals/jama/fullarticle/2844754