Comparison of Door to Needle Times for Three Fibrinolytic Strategies in Acute Ischemic Stroke

Alteplase remains the guideline-directed fibrinolytic of choice for acute ischemic stroke (AIS), however, tenecteplase has grown in popularity as new data have emerged. The purpose of this study is to compare door-to-needle (DTN) times for three fibrinolytic strategies: alteplase as drug of choice, tenecteplase as drug of choice, and choice of alteplase/tenecteplase based on institution use criteria.

This was a single-center retrospective cohort study including patients 18 years and older who presented to the emergency department and received alteplase or tenecteplase for AIS from November 1, 2018 to December 31, 2023. The primary outcome was DTN time calculated from emergency department arrival until fibrinolytic administration. Continuous data were assessed using a one-way ANOVA with Tukey HSD. Nominal data were assessed using a Chi-square test, and ordinal data were assessed using a Kruskal-Wallis test.

A total of 240 patients were evaluated for the study, with 80 patients in each of the three groups. There was no difference in DTN times between the alteplase, tenecteplase/alteplase, and tenecteplase groups (39, 47, 48 minutes, P = .25). The time from start of CT scan to fibrinolytic administration was significantly shorter between the alteplase and tenecteplase/alteplase groups (27, 38 minutes, P = .01).

This project highlighted the potential effects of having more than one fibrinolytic agent on formulary for acute ischemic stroke with different criteria for use. DTN time was not prolonged with two fibrinolytics on formulary.