Abstract TMP63: Blood Pressure (BP) Protocol Violations in IV Tenecteplase Treated Ischemic Stroke Patients is Associated With Early Neurologic Deterioration and Symptomatic Intracranial Hemorrhage

Abstract

Background: The American Heart Association guidelines recommend BP goal of <180/105 mmHg for the first 24 hours in acute ischemic stroke (AIS) patients treated with IV Alteplase and now adopted for IV Tenecteplase (TNK). Studies suggest increased hemorrhage risk in patients with BP ≥170 mmHg and greater BP variability. Methods: We performed a retrospective study with data from the Get with The Guidelines database and electronic medical record of all adult AIS patients treated with TNK at a Comprehensive Stroke Center from 6/2021 to 6/2023. All BP readings from ED arrival to 24 hours post TNK were queried. We analyzed the temporal trends of BP characteristics and their association with early neurological deterioration (END) and symptomatic intracranial hemorrhage (sICH). The BP characteristics included mean and standard deviation of systolic (SBP) and diastolic (DBP) measurements, intra-patient BP variability and frequency of excessive BP (SBP > 180 mmHg and DBP > 105 mmHg) at each time point. Results: There were 132 TNK treated patients: mean age 68 ± 15 years, 54% male, 73% Caucasian, median admission NIHSS 9, IQR 4-15, 42 (32%) underwent mechanical thrombectomy, 72 (54.5%) treated with IV antihypertensive(s). Of these, 6 (4.5%) developed END and another 6 (4.5%) sICH. Of the 5901 BP measurements, 217 (3.7%) and 99 (1.7%) exceeded systolic of >180 mmHg and diastolic of >105 mmHg respectively. All END and sICH patients had excessive BP within 4 hours post TNK (Figure 1) and during this time there was a strong association of END with excessive SBP (14% vs 4.8%; p=0.05) and DBP (14% vs 1.2%; p < 0.001). sICH had a similar but weaker association: excessive SBP (7.7% vs 4.9%; p=0.3) and excessive DBP (3.8% vs 1.4%; p=0.2). Conclusion: Our findings suggest that excessive BPs within 4 hours of TNK may be associated with patients developing END and sICH. Further exploration of moderate BP parameters deserve further study post thrombolysis, like the BEST II study in post thrombectomy patients.