LAUSR

Comment on ‘ Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomized, controlled, non-inferiority trial ’ which was published in Lancet. https://doi.org/10.1016/S0140-6736(22)01054-6. (cid:129) The Alteplase compared with Tenecteplase (AcT) trial 1 was an investigator-initiated, multicentre, parallel-group, open-label, registry-linked, randomized, controlled trial with blinded outcome assessment that involved patients with acute ischaemic stroke eligible for thrombolysis according to standard-of-care indications in Canada. The aim of the study was to determine whether the ef fi cacy of intravenous tenecteplase, as a single bolus at a dose of 0.25 mg/kg (to a maximum of 25 mg), was non-inferior to alteplase (0.9 mg/kg to a maximum of 90 mg; 0.09 mg/kg as a bolus; and then a 60-min infusion of the remaining 0.81 mg/kg). (cid:129) The primary outcome was the proportion of patients who had a modi fi ed Rankin Scale (mRS) score of 0 – 1 at 90 – 120 days after treatment, assessed via blinded review in the intention-to-treat (ITT) population. The mRS score is a seven-point ordered categorical scale from 0 to 6 for functional neurological outcome, with 0 indicating no neurological symptoms and 6 indicating death. Non-inferiority was met if the lower bound of the 95% con fi dence interval (CI) for the difference in the proportion of patients who