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Prospective Observational Cohort Study of Tenecteplase Versus Alteplase in Routine Clinical Practice.

Steven J Warach1,2, Adrienne N Dula1, Truman J Milling1,2

  • 1Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).

Stroke
|September 23, 2022
PubMed
Summary
This summary is machine-generated.

Tenecteplase use in stroke care significantly reduced door-to-needle and transfer times, demonstrating noninferior clinical outcomes and lower hospital costs compared to alteplase. Further multicenter studies are recommended for broader validation.

Keywords:
hospitalischemic strokemorbiditystandard of caretenecteplase

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Area of Science:

  • Neurology
  • Pharmacology
  • Health Services Research

Background:

  • A 10-hospital network adopted tenecteplase for stroke thrombolysis, replacing alteplase, due to workflow benefits and reported noninferior outcomes.
  • This study evaluated tenecteplase's real-world impact on workflow efficiency and clinical outcomes in stroke patients.

Purpose of the Study:

  • To assess if switching to tenecteplase reduced thrombolytic workflow times.
  • To determine if tenecteplase achieved noninferior clinical outcomes compared to alteplase.
  • To compare the total hospital costs associated with tenecteplase versus alteplase treatment.

Main Methods:

  • A prospective, registry-based, observational study compared tenecteplase (n=234) and alteplase (n=354) treated stroke patients.
  • Key metrics included door-to-needle time, door-in-door-out time, favorable and unfavorable clinical outcomes, and hospital costs.

Main Results:

  • Tenecteplase use was associated with superior door-to-needle (41% vs 29%) and door-in-door-out times (37% vs 14%).
  • Favorable outcomes for tenecteplase were noninferior (within the 6.5% margin), and unfavorable outcomes were reduced (7.3% vs 11.9%).
  • Tenecteplase treatment resulted in significantly lower median hospital costs ($13,382 vs $15,841).

Conclusions:

  • Switching to tenecteplase in clinical practice improved workflow efficiency and reduced costs.
  • Tenecteplase demonstrated noninferior favorable clinical outcomes and reduced unfavorable outcomes.
  • Larger, multicenter studies are recommended to generalize these findings.