Abstract
Background: Published data suggests tenecteplase (TNKase) is non-inferior to alteplase for acute ischemic stroke treatment. TNKase has certain advantages over alteplase including single-bolus administration. We evaluated TNKase performance in all acute stroke patients in a large integrated healthcare system. Methods: In 2016, we launched a standardized telestroke program for 21 certified stroke centers to include immediate video evaluation by a teleneurologist. In November 2020, we transitioned all centers to use TNKase for qualifying stroke patients presenting within 4.5 hours of last time known well. Selection criteria were the same as those for alteplase. Our study cohort included all potential acute stroke patients evaluated by telestroke. We compared the TNKase cohort treated during 12/1/20 - 3/31/21 to the alteplase cohort during 5/1/20 - 8/31/20. Assessment included demographics, mode of arrival, initial NIHSS, neuroimaging results, large vessel occlusion, rate of intracranial hemorrhage (ICH), discharge outcomes, percent with mRS (0-2) and mortality at 90 days with 95% CI. Results: Study cohort had 301 patients treated with TNKase and 248 patients with alteplase. Average age was about 70 years. Compared to alteplase, TNKase was associated significantly with faster door-to-needle (DTN) and door-in-door-out (DIDO) times [Table]. TNKase cohort had a larger percentage of stroke mimics. There was a trend of less symptomatic hemorrhage seen with TNKase. Multivariate model revealed that TNKase treatment was less likely to have 90-day mortality (OR=0.56, 95% CI 0.33-0.96, p=0.04). Percent 90-day favorable mRS score (0-2) was no different between the cohorts. Conclusions: We have successfully and safely transitioned to using TNKase for acute stroke treatment in our community setting. Compared to alteplase, TNKase cohort achieved faster DTN and DIDO times and less 90-day mortality. Further evaluation is needed to examine 90-day mRS in larger cohorts.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
