Abstract TP42: Door To Thrombolysis Administration Times Before And After Tenecteplase Implementation Across Different Hospital Types

Abstract

Background: The switch from alteplase to tenecteplase as a thrombolytic in acute ischemic stroke has been reported to be associated with faster door-to-needle (DTN) times. We aimed to study the effect of the early transitional experience after tenecteplase switch on DTN across different hospital types. Methods: We retrospectively analyzed prospectively collected data of patients that underwent thrombolysis at 7 free-standing emergency departments (FSEDs), 8 primary stroke centers (PSC), 3 thrombectomy-capable stroke centers (TSC), and a comprehensive stroke center (CSC) in a large healthcare system. The distributions of DTN time before (January 2021-January 2022) and after (January 2022-June 2022) tenecteplase implementation were compared. The Mann-Whitney test was used to compare door-to-needle time differences between alteplase and tenecteplase treatment groups. Results: Alteplase was given to 318 patients with a median DTN of 40 minutes (interquartile range [IQR]: 27;57) and 154 received tenecteplase with a median DTN of 46 minutes (IQR: 33;63). Patients in the two groups had similar demographic characteristics, NIH Stroke Scale scores, and patient distribution across hospital types. Among tenecteplase-treated patients, 68 (44%) were from FSEDs and PSCs, 67 (44%) were from TSCs, and 19 (12%) were from CSCs. The median DTN time at FSEDs and PSCs increased from 39 (IQR: 27;55) to 56 minutes (IQR: 41;72) after tenecteplase implementation (P<0.0001). At the TSCs the median DTN was 40 minutes (IQR: 29;55) and did not change after the switch to tenecteplase (P=0.31). The median DTN at CSC in the alteplase group was 41 minutes (IQR: 26;72) and 33 minutes (IQR:20;45) in the tenecteplase group (P=0.06). Conclusion: For the first 6 months of tenecteplase implementation the DTN time increased at FSEDs and PSCs but remained unchanged in higher volume centers.