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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Tenecteplase Improves Door-to-Needle Time in Real-World Acute Stroke Treatment.

Jillian Hall1, Jesse M Thon2, Mark Heslin1

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PubMed
Summary

Tenecteplase significantly reduced door-to-needle times for acute ischemic stroke patients compared to alteplase (tPA). This switch in treatment improved efficiency without increasing hemorrhage risk, highlighting tenecteplase

Keywords:
acute strokedoor‐to‐needleprocess improvementtenecteplasethrombolysis

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Pharmacology

Background:

  • A process improvement initiative at a comprehensive stroke center involved switching from alteplase (tPA) to tenecteplase for eligible acute ischemic stroke patients.
  • This study reports interim results of this initiative.

Purpose of the Study:

  • To compare the efficacy of tenecteplase versus alteplase (tPA) in reducing door-to-needle (DTN) times for acute ischemic stroke.
  • To assess the safety profile, specifically symptomatic intracranial hemorrhage rates, associated with tenecteplase use.

Main Methods:

  • A retrospective analysis of a prospectively maintained single-center registry of acute ischemic stroke patients.
  • Comparison of patients treated with alteplase (tPA) before May 2020 versus tenecteplase after May 2020.
  • Logistic regression analysis was used to determine the independent effect of tenecteplase on achieving DTN time ≤45 minutes, with negative controls used to validate throughput.

Main Results:

  • Tenecteplase use was associated with significantly faster median DTN times (41 minutes) compared to alteplase (tPA) (58 minutes) (P<0.01).
  • No significant difference in symptomatic intracranial hemorrhage rates was observed between the two treatments (2% vs 7%; P=0.37).
  • Tenecteplase remained independently predictive of achieving DTN time ≤45 minutes, even with a higher proportion of transferred patients.

Conclusions:

  • Tenecteplase administration resulted in faster DTN times for acute ischemic stroke patients compared to alteplase (tPA).
  • The simplified single bolus administration of tenecteplase likely contributes to improved treatment efficiency.
  • The findings support tenecteplase as an effective alternative for improving acute ischemic stroke treatment workflows.