Lauren Beauchamp Franciscan Health Indianapolis, United States
Introduction: The two mainstays of treatment for acute ischemic stroke include fibrinolytic therapy and mechanical thrombectomy. The 2019 Acute Ischemic Stroke Guidelines published by the American Heart Association and American Stroke Association focus on the use of alteplase for fibrinolytic therapy; however, in clinical practice, there has been an increased use of tenecteplase. Tenecteplase is more fibrin specific, more resistant to plasminogen activator inhibitor-1 and has a longer duration of action when compared to alteplase. These characteristics allow for tenecteplase to be administered as a single bolus dose, potentially leading to a reduction in door-to-needle time. The objective of this study was to evaluate whether tenecteplase shortened door-to-needle time and improved clinical outcomes in comparison to alteplase. The institution transitioned to tenecteplase as the primary fibrinolytic agent for stroke on September 6, 2021.
Methods: A retrospective chart review of patients with acute ischemic stroke who received alteplase from September 6, 2020, through September 5, 2021, or tenecteplase from September 6, 2021, through September 5, 2022, was performed. The primary endpoint evaluated door-to-needle time. Key secondary endpoints included time to thrombectomy in eligible patients and major bleeding.
Results: A total of 92 patients were included with 42 patients and 50 patients in the alteplase and tenecteplase groups, respectively. Door-to-needle time was similar between groups, with a median time of 48.5 [38.8-62] minutes in those managed with alteplase versus 48 [36.3-67.8] minutes in those treated with tenecteplase (p=0.959). The median time to thrombectomy did not significantly differ at 147 [101-153] minutes with alteplase versus 119 [110.5-141.5] minutes with tenecteplase (p=1.00). Hemorrhagic conversion occurred in 7.3% of patients who received alteplase versus 18.4% of patients who received tenecteplase (p=0.125). All doses administered were appropriate for stroke.
Conclusions: The use of tenecteplase resulted in similar door-to-needle time and clinical outcomes when compared to alteplase for acute ischemic stroke.
