Abstract WMP29: “Good Times”: Has The Change From Tissue Plasminogen Activator To Tenecteplase For Acute Ischemic Stroke Improved Treatment Times?

Abstract

Background: Stroke is the leading cause of disability and the 5th leading cause of death in the US. The advent of tissue plasminogen activator (TPA) was a game changer in the treatment of acute ischemic stroke. Today at Cedars Sinai Medical Center, we have implemented the use of Tenecteplase (TNK) for our Code Brain patients, a more cost-effective, easier- to- use thrombolytic. TNK is non- inferior to TPA and studies show a potential benefit in reperfusion of large vessel occlusions (NEJM, 2018). Hypothesis: To decrease the ED and inpatient door-to-needle (DTN) times, and thrombolytic with thrombectomy (bridge) door-to-groin (DTG) puncture times, by June 20, 2021 using TNK, as measured by data acquired 6 months prior to TNK implementation (July 20, 2020 through January 19, 2021) and data acquired 6 months after TNK implementation (January 20, 2021 through June 20, 2021). Implementation: We performed a retrospective chart review of times for patients who received TNK alone and: for those who received bridge therapy after TNK implementation. These times were compared with 6 months of data prior to TNK implementation. Results: Our review of the data revealed that the median times for ED DTN, in-house DTN and bridge DTP were 46, 61.5, and 98.5 minutes respectively. Data for six months after the implementation of TNK reveals that the median times for ED DTN, in-house DTN and bridge DTP were 48, 51.5, and 88 minutes respectively. Conclusions: We discovered that although ED DTN times were unremarkable, our in-house DTN times and bridge DTP times markedly improved. In fact, for the first time, we have surpassed the American Heart Association benchmark of 90 minutes DTP times. We conclude that TNK is easier to administer, more cost effective, and decreased our treatment times for our in-house Code Brain patients who received TNK alone and our Code brain patients who received bridge therapy. We will continue to track and trend this data and seek out areas of improvement.