Study of Tenecteplase Versus Alteplase for Thrombolysis (Clot Dissolving) in Acute Ischemic Stroke "NOR-TEST"


Phase 3 Results N/A

Trial Description

BACKGROUND: Alteplase dissolves blood vessel clots in acute ischemic stroke and is the only approved acute drug treatment <4½ hours of stroke onset. The overall benefit from alteplase is substantial, but up to 2/3 of patients with large artery clots may not achieve reopening of the vessel and up to 40% of the patients may remain severely disabled or die, leaving substantial room for improvement. Tenecteplase, widely used in coronary heart disease, may be more effective and may have less bleeding complications than alteplase, and may be the drug of choice also in stroke.
HYPOTHESIS: Tenecteplase may be given safely to patients with acute ischemic stroke at a dose that is associated with improved clinical outcome compared with existing treatment options.
AIMS: To compare efficacy and safety of tenecteplase vs. alteplase given <4½ hours after symptom onset.
STUDY ENDPOINTS: The primary study endpoint is excellent clinical outcome at 3 months (effect). Secondary study endpoints are major early clinical improvement (effect) and bleeding complications (safety).

Detailed Description

HYPOTHESIS: 1) Tenecteplase 0.4 mg/kg may be given safely to patients with acute ischaemic stroke <4½ hours after stroke onset. 2) Tenecteplase 0,4 mg/kg (single bolus)has superior efficacy and safety compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) when given within 4 ½ hours after stroke onset.
DESIGN: NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial with randomisation tenecteplase:alteplase 1:1.
POWER CALCULATION: NOR-TEST aims at detecting a 9 % higher percentage excellent outcome with tenecteplase vs. alteplase (r1=0.40; r2=0.49; OR 1.44; power 0.8), and will include 954 patients during 3 years.
PATIENT RECRUITMENT: All patients found eligible for thrombolytic therapy are eligible for NOR-TEST, i.e. NOR-TEST changes neither inclusion nor exclusion criteria. The number of patients treated at a participating centre will therefore essentially remain unchanged. Estimated 400 patients are thrombolysed per year in participating centres. Allowing for 20% of patients not being included in NOR-TEST, the total number of patients (n=954) will still be met.



  • Tenecteplase (TNKase)Drug
    Other Names: Metalyse
    Intervention Desc: 0.4 mg/kg single bolus intravenously
    ARM 1: Kind: Experimental
    Label: Tenecteplase
    Description: 0.4 mg/kg single bolus intravenously
  • Alteplase Drug
    Intervention Desc: 0.9 mg/kg as 10% bolus + 90% infusion/60 minutes intravenously
    ARM 1: Kind: Experimental
    Label: Alteplase
    Description: 0.9 mg/kg as 10% bolus + 90% infusion/60 minutes intravenously

Trial Design

  • Allocation: Randomized
  • Masking: Double Blind (Subject, Outcomes Assessor)
  • Purpose: Treatment
  • Endpoint: Safety/Efficacy Study
  • Intervention: Parallel Assignment


Type Measure Time Frame Safety Issue
Primary Functional handicap 90 days No
Secondary Symptomatic cerebral hemorrhage 24-36 hours Yes
Secondary Hemorrhagic transformation 24-36 hours Yes
Secondary Major neurological improvement 24 hours No
Primary Proof of concept: Neurological improvement 24 hours No
Primary Clinical: Functional handicap 90 days No
Secondary Infarct volume and location(s) 24-36 hours No
Secondary Neurological improvement 24 hours
Secondary Safety 90 days