(634) Evaluating the Time From Treatment Decision to Administration of Alteplase Versus Tenecteplase

Introduction: Acute ischemic stroke (AIS) is one of the leading causes of morbidity in the United States (US). The American Heart Association and American Stroke Association recommend thrombolytic therapy for patients diagnosed with AIS who present within 4.5 hours of symptom onset and do not have exclusions for thrombolysis. Currently, the only thrombolytics recommended for AIS in the US are alteplase and tenecteplase. In January of 2022, our hospital adopted tenecteplase as the sole thrombolytic for AIS. Given practice advantages with the use of tenecteplase, including the simplicity of a single bolus dose, the time to administration of thrombolytic may be reduced.

Methods: This was a retrospective review of adult patients presenting to a 451-bed primary stroke center who received a thrombolytic for the treatment of AIS from April 2021 to August 2022. A teleneurology database and the electronic health record were used to identify patients who received either thrombolytic during the study period. The primary outcome was comparing the time from treatment decision to thrombolytic administration. Secondary outcomes were evaluating safety and efficacy by reviewing adverse events and change in National Institutes of Health Stroke Scale within 24 hours of thrombolytic administration.

Results: A total of 96 patients were evaluated for the primary outcome with 57 in the alteplase group and 39 in the tenecteplase group. No significant differences were seen in patient demographics or stroke characteristics. The average time from treatment decision to thrombolytic administration were 13.6 minutes in the alteplase group vs. 12.5 minutes in the tenecteplase group (p=0.62). No differences were found in the secondary outcomes of safety and efficacy.

Conclusions: Although not statistically significant, the difference in time from treatment decision to administration may be clinically relevant as reducing time to treatment is an important consideration in AIS. While trials have explored the time from symptom onset to administration of thrombolytic therapy, this is the first trial, to our knowledge, that attempted to find a difference in time from treatment decision to administration. Further studies are needed to verify if there is a statistically or clinically significant difference in decision to administration time.