With several trials showing tenecteplase to be non-inferior to alteplase for acute ischemic stroke, notably, the Canadian AcT trial, ^{Reference Menon, Buck and Singh1} alongside its well-recognized practical advantages, ^{Reference Wang, Hao, Wu, Wu, Fisher and Xiong2} tenecteplase is rapidly being adopted globally as the standard of care for stroke thrombolysis. In fact, the Food and Drug Administration in the USA recently approved it for use in adults with stroke.

The study by Halabi and collaborators ^{Reference Halabi, Stang and Menon3} offers an excellent example of how a coordinated, system-level approach within a single-payer healthcare setting can support a safe and generally seamless transition from alteplase to tenecteplase for routine stroke care. The authors describe their experience in Alberta, Canada, and found comparable outcomes with tenecteplase in terms of effectiveness and adverse events. While very few dosing errors occurred, and none resulted in serious complications – namely, hemorrhage – it is important to emphasize that clear protocols and dedicated teaching for stakeholders are critical to minimizing such risks during transitions in practice.

A key strength of the study is its integration of multiple data sources, including quality registries, real-world evidence and administrative datasets, combined with a collaborative, cross-sectoral effort involving public health agencies and academic institutions. This multidimensional strategy offers policymakers in other health systems an evidence base and guidance to support a transition to tenecteplase in their own jurisdictions.

When this problem is viewed from a global health perspective, it is crucial to appreciate the considerable hurdles to introducing tenecteplase in regions where access to alteplase is already limited or problematic. In many regions of the world, alteplase – the current standard of care in thrombolysis – is not universally available, and the implementation of tenecteplase as a new standard, despite its many logistical advantages, may be an even more formidable obstacle. ^{Reference De Souza, Sebastian and Wan Zaidi4} However, applicability and transferability of the Alberta experience provide other systems with a convincing model to adapt for the safe, equitable and evidence-based evolution of acute stroke treatments.