Abstract
Background and Purpose: Tenecteplase (TNK) has recently been demonstrated to be an effective thrombolytic agent in patients with acute ischemic stroke. Our 9-hospital stroke network transitioned to tenecteplase as the standard stroke thrombolytic in April 2022. We assessed the impact of TNK use in routine clinical practice on quality metrics and outcomes. Methods: System Stroke Committee (Vascular Neurology, Emergency Medicine, Pharmacy, Nursing) evaluated the scientific evidence, performed a cost analysis and decided to implement TNK system wide. Proposal was submitted to Pharmacy and Therapeutics (P&T) committee. Education plan for providers, nursing and pharmacy was developed and training provided. A before and after analysis was conducted to compare consecutive patients who received thrombolysis for acute ischemic stroke between Jan 2022 to July 2022 before and after the transition to tenecteplase. Quality metrics of National Institute of Health Stroke Scale (NIHSS) on presentation, door to thrombolysis; door in door out of the regional facility; safety outcome of any hemorrhagic transformation and functional outcome of NIHSS at discharge are compared between patients who received TNK versus tPA. Results: A total of 121 ischemic stroke patients treated with thrombolysis were included: 62 patients received TNK and 59 patients received tPA. NIHSS on presentation was similar between the groups (TNK 8 IQR [2-10] vs. tPA 7 IQR [3-11] p=0.73). Door to thrombolysis was similar (TNK 60.3±40.9 min vs. 60.1±44 min; p=0.98) as was door-in-door out time (TNK 186±68.4 min vs. tPA 145±70 min p=0.09) between the groups. Intracerebral hemorrhage rates were not different (TNK 8% vs. tPA 6% p=0.78). Discharge NIHSS was similar between the groups (TNK 1 IQR [0-5] vs. tPA 1 IQR [0-4]; p=0.85). Conclusion: Tenecteplase implementation as stroke thrombolytic of choice in a large stroke network did not impact performance on quality metrics, safety and outcomes.
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