Observational Study to Assess the Safety of rhTNK-tPA (Mingfule®) vs. Rt-PA (Actilyse®) in Treating Acute Ischemic Stroke

This is a multicenter, prospective, non-randomized, parallel-group, post-marketing safety surveillance cohort study conducted in routine clinical practice to compare the safety of intravenous thrombolysis with rhTNK-tPA (Mingfule®) versus rt-PA (Actilyse®) in patients with acute ischemic stroke. As a non-interventional observational study, no randomization or blinding is applied. The choice of thrombolytic agent is determined solely by the treating physician in accordance with clinical guidelines and individual patient circumstances. Patients are assigned to one of two groups based on the actual treatment received:

rhTNK-tPA group: Administered 0.25 mg/kg (maximum 25 mg) as a single intravenous bolus injection per the approved package insert.

rt-PA group: Administered 0.9 mg/kg per the approved package insert, with 10% of the total dose given as an intravenous bolus and the remaining 90% infused continuously over 60 minutes.

The target sample size is approximately 4,500 patients, with about 3,000 in the rhTNK-tPA group and at least 1,500 in the rt-PA group. This sample size is selected to fulfill the regulatory requirements for post-marketing intensive monitoring and to ensure sufficient statistical precision for safety comparisons between the two treatment groups.

Inclusion criteria

• Adult patients aged 18 years or older.
• Time from symptom onset to treatment < 4.5 hours, with the time of symptom onset defined as "last known normal time".
• Meet the diagnostic criteria for acute ischemic stroke, confirmed by imaging (head CT or MRI).
• Baseline National Institutes of Health Stroke Scale (NIHSS) score ≤ 25 points at admission.
• Planned to receive intravenous thrombolysis with either rhTNK-tPA (Mingfule®) 0.25 mg/kg or rt-PA (Actilyse®) 0.9 mg/kg.
• Voluntary signing of the informed consent form by the participant or their legal guardian.
• Have complete clinical and imaging data, and be able to cooperate with follow-up assessments.

Exclusion criteria

• Patients with absolute contraindications to reperfusion therapy (including intravenous thrombolysis and mechanical thrombectomy), specifically:

Intracranial hemorrhage (including parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural/epidural hematoma, etc.) History of prior intracranial hemorrhage Severe head trauma or stroke within the past 3 months Intracranial tumor or giant intracranial aneurysm Intracranial or intraspinal surgery within the past 3 months Major surgical procedure within the past 2 weeks Gastrointestinal or urinary tract bleeding within the past 3 weeks Active visceral bleeding Aortic arch dissection Arterial puncture at a non-compressible site within the past 1 week 11 Elevated blood pressure: systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 100 mmHg 12 Acute bleeding diathesis, including platelet count < 100×10⁹/L or other conditions 13 Treatment with low molecular weight heparin within the past 24 hours 14 Oral anticoagulant use (warfarin) with INR > 1.7 or PT > 15 seconds 15 Use of thrombin inhibitors or factor Xa inhibitors within the past 48 hours, or abnormal laboratory tests deemed by the investigator to contraindicate thrombolysis (e.g., APTT, INR, platelet count, ECT, TT, or factor Xa activity assay) 16 Random blood glucose < 2.8 mmol/L or > 22.22 mmol/L 17 Head CT or MRI showing large-area infarction (infarct volume > 1/3 of the middle cerebral artery territory)

• Known pregnant or lactating female patients (judged by the investigator based on last menstrual period, medical history, or patient/family report).
• Patients who have received prior reperfusion therapy outside the hospital (including intravenous thrombolysis and endovascular treatment).
• Patients expected to be unable to complete follow-up (e.g., predicted survival < 3 months, or inability to comply with follow-up plans for other reasons).
• Patients participating in other clinical trials where the interventions may affect the results of this study.