A Randomized Controlled Trial of TNK-tPA Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion
Summary
This trial will enroll patients that have been diagnosed with a transient ischemic attack (TIA) or minor stroke that has occurred within the past 12 hours. Anyone diagnosed with a minor stroke faces the possibility of long-term disability and even death, regardless of treatment. Stroke symptoms such as weakness, difficulty speaking and paralysis may improve or worsen over the hours or days immediately following a stroke. TEMPO-2 is a minor stroke trial for patients presenting within 12 hours of their symptom onset. Patients will be randomized to TNK-tPA or standard of care. In the intervention group TNK-tPA is given as a single, intravenous bolus (0.25mg/Kg) immediately upon randomization. Maximum dose 50mg. The control group will receive antiplatelet agent(s) as decided by the treating physician. Antiplatelet agent(s) choice will be at the treating physician's discretion. TEMPO-2 Coordinating Centre is located in Calgary, AB, Canada. There will be approximately 50 sites participating worldwide. Dr. Shelagh Coutts is the Principal Investigator.
Timeline
- Start
- 2015-04-01
- Primary completion
- 2024-01-19
- Completion
- 2024-04-10
Publications
- Results Coutts SB, Ankolekar S, Appireddy R, Arenillas JF, Assis Z, Bailey P, Barber PA, Bazan R, Buck BH, Butcher KS, Camden MC, Campbell BCV, Casaubon LK, Catanese L, Chatterjee K, Choi PMC, Clarke B, Dowlatshahi D, Ferrari J, Field TS, Ganesh A, Ghia D, Goyal M, Greisenegger S, Halse O, Horn M, Hunter G, Imoukhuede O, Kelly PJ, Kennedy J, Kenney C, Kleinig TJ, Krishnan K, Lima F, Mandzia JL, Marko M, Martins SO, Medvedev G, Menon BK, Mishra SM, Molina C, Moussaddy A, Muir KW, Parsons MW, Penn AMW, Pille A, Pontes-Neto OM, Roffe C, Serena J, Simister R, Singh N, Spratt N, Strbian D, Tham CH, Wiggam MI, Williams DJ, Willmot MR, Wu T, Yu AYX, Zachariah G, Zafar A, Zerna C, Hill MD; TEMPO-2 investigators. Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial. Lancet. 2024 Jun 15;403(10444):2597-2605. doi: 10.1016/S0140-6736(24)00921-8. Epub 2024 May 17.
- Singh N, Strbian D, Vatanpour S, Field TS, Yu AYX, Ganesh A, Barber PA, Choi PMC, Buck BH, Kleinig TJ, Campbell B, Molina C, Muir KW, Hill MD, Coutts SB. Association of Successful Recanalization and Functional Outcomes in Minor Ischemic Stroke With Proven Occlusion: A Secondary Analysis of TEMPO-2 Trial. Stroke. 2026 Jun 19. doi: 10.1161/STROKEAHA.125.052872. Online ahead of print.
- Ganesh A, Vatanpour S, Yu AYX, Barber P, Choi PMC, Field TS, Kate MP, Kleinig TJ, Shamy MCF, Chatterjee K, Molina CA, Campbell BCV, Appireddy R, Muir KW, Hill MD, Coutts SB; as the TEMPO-2 investigators. Outcomes After Minor Ischemic Stroke in Older Patients Treated With IV Thrombolysis vs Standard of Care in the TEMPO-2 Trial. Neurology. 2026 May 12;106(9):e214925. doi: 10.1212/WNL.0000000000214925. Epub 2026 Apr 14.
- Zhang Y, Buck BH, Barber PA, Chatterjee K, Clarke B, Choi PMC, Hunter G, Ganesh A, Mishra SM, Williams D, Campbell BCV, Dowlatshahi D, Butcher KS, Krishnan K, Wiggam MI, Kleinig TJ, Muir KW, Zerna C, Field TS, Goyal M, Yu AYX, Roffe C, Demchuck AM, Parsons MW, Bazan R, Ankolekar S, Kennedy J, Menon BK, Mandzia JL, Pille A, Kelly PJ, Marko M, Singh N, Vatanpour S, Lima FO, Catanese L, Horn M, Ghia D, Ferrari J, Greisenegger S, Hill MD, Coutts SB; TEMPO-2 Investigators. Thrombolysis With Tenecteplase for Minor Disabling Stroke: Secondary Analysis of the TEMPO-2 Randomized Clinical Trial. JAMA Neurol. 2025 Dec 1;82(12):1243-1250. doi: 10.1001/jamaneurol.2025.4152.
- Singh N, Kenney CC, Butcher KS, Buck B, Barber PA, Field TS, Choi PM, Yu AY, Kleinig T, Appireddy R, Molina CA, Muir KW, Hill MD, Coutts SB. A Randomized Controlled Trial of Tenecteplase Versus Standard of Care for Minor Ischemic Stroke with Proven Occlusion (TEMPO-2): Rational and design of a multicenter, randomized open-label clinical trial. Int J Stroke. 2024 Aug;19(7):817-822. doi: 10.1177/17474930241253702. Epub 2024 May 17.
- Logallo N, Kvistad CE, Thomassen L. Therapeutic Potential of Tenecteplase in the Management of Acute Ischemic Stroke. CNS Drugs. 2015;29(10):811-8. doi: 10.1007/s40263-015-0280-9.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Tenecteplase | Protein / enzyme biologic | 0.25 mg/kg | Intravenous |
| Background | Aspirin | Small molecule | — | — |
| Background | Clopidogrel | Small molecule | — | — |