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Easy-to-Administer Tenecteplase Reasonable Alternative to Alteplase for Acute Ischemic Stroke
Intravenous tenecteplase is a reasonable alternative to alteplase for the treatment of acute ischemic stroke in all patients who meet standard criteria for thrombolysis, according to study results published in The Lancet.
“[T]hese findings could revolutionize stroke treatment throughout the world,” said study co-principal investigator Bijoy Menon, MD, a professor at the University of Calgary and neurologist at the Foothills Medical Centre in Calgary, Alberta, Canada. “Tenecteplase is known to be an effective clot-dissolving drug. It is very easy to administer, which makes it a game changer when seconds count to save brain cells.”
The current global standard of care for acute ischemic stroke is intravenous thrombolysis with alteplase bolus followed by infusion. The process takes up to an hour, requires an infusion pump and monitoring, and can be cumbersome for patients requiring transport. Commonly used to dissolve blood clots during a heart attack, tenecteplase attaches itself to the clot for a longer period than alteplase with just one dose.
Related: Reviews and Insights From the 2022 European Stroke Organisation Conference
The randomized, noninferiority trial compared intravenous tenecteplase with alteplase in adults presenting with acute ischemic stroke at 22 primary comprehensive stroke centers in Canada. Between December 10, 2019, and January 25, 2022, 1600 patients were enrolled.
According to results, 36.9% of patients in the tenecteplase group and 34.8% in the alteplase group had a modified Rankin Scale score of 0-1 at 90 to 120 days after treatment. At a 2.1% difference, tenecteplase met the trial’s prespecified 5% threshold for noninferiority to alteplase.
Safety analyses showed 24-hour symptomatic intracerebral hemorrhage occurred in 3.4% of patients in the tenecteplase group compared with 3.2% in the alteplase group. Mortality rates within 90 days of treatment were 15.3% in the tenecteplase group and 15.4% in the alteplase group.
“One of the reasons tenecteplase is so effective is that in can be administered as a single, immediate dose,” said study co-principal investigator Rick Swartz, MD, PhD, clinician-researcher at the University of Toronto and stroke neurologist at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. “That’s a big advantage, saving critical time and complication. Tenecteplase could potentially be administered wherever the patient is seen first, at a medical center or small hospital.”
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