Switching to Tenecteplase for Stroke Thrombolysis

Mahawish, Karim; Gommans, John; Kleinig, Timothy; Lallu, Bhavesh; Tyson, Alicia; Ranta, Annemarei

doi:10.1161/strokeaha.121.035931

Cited by 43 publications

(36 citation statements)

References 4 publications

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“…The use of Tenecteplase for AIS thrombolysis at an MRI-based, urban U.S. comprehensive stroke center was feasible with comparable safety and functional outcomes compared to Alteplase. Despite 13% of unwitnessed onset AIS patients and a higher proportion of the African American population, our experience is consistent with two prior real-world data reports [4,5] and a meta-analysis of 5 trials with regard to safety and outcomes [1]. Our data add to the accumulating evidence and generalizability in support of the use of Tenecteplase for AIS IV thrombolysis, including in unwitnessed onset patients screened with MRI.…”

Section: Discussionsupporting

confidence: 88%

Tenecteplase for Intravenous Thrombolysis of Ischemic Stroke: A Single MRI-based Comprehensive Stroke Center Experience

Kim

Upadhyaya

Moriarty-Poole

et al. 2022

Preprint

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Background: Tenecteplase is a tissue plasminogen activator with higher fibrin specificity compared with Alteplase. Accumulating data suggests that intravenous Tenecteplase 0.25mg/kg is non-inferior to Alteplase 0.9mg/kg for acute ischemic stroke. We describe our 10-months experience. Methods: At our MRI-based, urban comprehensive stroke center, we switched the intravenous thrombolytic agent for acute ischemic stroke to Tenecteplase 0.25mg/kg on March 23, 2021. Until January 31, 2022, 62 stroke patients were treated with Tenecteplase. We compared clinical and safety outcomes of Tenecteplase-treated patients with 94 Alteplase-treated patients. Results: During the study period, nine (15%) patients with unknown stroke onset were thrombolyzed with MRI screening. Nineteen (35%) patients underwent subsequent thrombectomy. When compared with Alteplase-treated patients, there was no difference with Tenecteplase-treated patients in 90-day functional outcome, death, symptomatic intracranial hemorrhage, or angioedema. Conclusions: The use of Tenecteplase for stroke thrombolysis was feasible with comparable safety and functional outcomes compared to Alteplase, even when Tenecteplase was administered based on MRI screening to stroke patients with unknown onset.

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Section: Discussionsupporting

confidence: 88%

Tenecteplase for Intravenous Thrombolysis of Ischemic Stroke: A Single MRI-based Comprehensive Stroke Center Experience

Kim

Upadhyaya

Moriarty-Poole

et al. 2022

Preprint

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“…14,15 Characteristics of the studies that were eligible for the meta-analysis are presented in Table 1. [16][17][18][19][20][21] In the quality control of included studies, we noted selection issues with cases (tenecteplase treatment) and controls (alteplase treatment) (eTable 4 in the Supplement). Alemseged et al 16 included only patients with basilar artery occlusion treated with either intravenous tenecteplase or intravenous alteplase, thus limiting the generalizability of their findings.…”

Section: Resultsmentioning

confidence: 99%

“…Two of these studies were excluded—one included overlapping participant data with another publication and the other included no intravenous alteplase treatment control group (Figure 1). Characteristics of the studies that were eligible for the meta-analysis are presented in Table 1 …”

Section: Resultsmentioning

confidence: 99%

“…In the study by Seners et al, the control group comprised hospitalized patients with AIS who received alteplase treatment at different institutions. In the studies by Psychogios et al and Mahawish et al, data on patients treated with intravenous tenecteplase were prospectively collected; however, those who received intravenous alteplase were from historical cohorts at these same institutions. Regarding outcome assessment, 3 of 6 studies reported no blinding of outcome adjudicators to treatment .…”

Section: Resultsmentioning

confidence: 99%

“…Regarding outcome assessment, 3 of 6 studies reported no blinding of outcome adjudicators to treatment. [18][19][20] In addition, one of these studies 20 reported a substantial proportion of patients lost to 3-month follow-up with imbalance in lost-to-follow-up rates between patients treated with intravenous alteplase (50 [18%]) or intravenous tenecteplase (77 [14%]).The full text of 1 of the studies had not been published at the time of our systematic review; thus, bias assessment was not possible. 21 Unadjusted and adjusted analyses for primary and secondary outcomes of interest are briefly summarized in 2C) and adjusted OR (7.60; 95% CI, 1.97-29.41) (Figure 3C).…”

Section: Jama Network Open | Neurologymentioning

confidence: 99%

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Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke

et al. 2022

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Key Points Question How does the use of tenecteplase compare with the use of alteplase in the clinical outcomes of patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis? Findings In this systematic review and meta-analysis, 6 nonrandomized studies including 1820 participants were analyzed. Intravenous tenecteplase was associated with better short-term and long-term functional outcomes in patients with AIS and a higher likelihood of successful recanalization in patients with acute intracranial vessel occlusions; no increased risk of intracranial bleeding was noted with intravenous tenecteplase compared with alteplase. Meaning Analysis of evidence from nonrandomized studies suggests that tenecteplase is as safe as alteplase for the treatment of AIS and tenecteplase is potentially associated with more favorable outcomes.

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Symptomatic Intracranial Hemorrhage With Tenecteplase vs Alteplase in Patients With Acute Ischemic Stroke

et al. 2023

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ImportanceSymptomatic intracranial hemorrhage (sICH) is a serious complication of stroke thrombolytic therapy. Many stroke centers have adopted 0.25-mg/kg tenecteplase instead of alteplase for stroke thrombolysis based on evidence from randomized comparisons to alteplase as well as for its practical advantages. There have been no significant differences in symptomatic intracranial hemorrhage (sICH) reported from randomized clinical trials or published case series for the 0.25-mg/Kg dose.ObjectiveTo assess the risk of sICH following ischemic stroke in patients treated with tenecteplase compared to those treated with alteplase.Design, Setting, and ParticipantsThis was a retrospective observational study using data from the large multicenter international Comparative Effectiveness of Routine Tenecteplase vs Alteplase in Acute Ischemic Stroke (CERTAIN) collaboration comprising deidentified data on patients with ischemic stroke treated with intravenous thrombolysis. Data from more than 100 hospitals in New Zealand, Australia, and the US that used alteplase or tenecteplase for patients treated between July 1, 2018, and June 30, 2021, were included for analysis. Participating centers included a mix of nonthrombectomy- and thrombectomy-capacity comprehensive stroke centers. Standardized data were abstracted and harmonized from local or regional clinical registries. Consecutive patients with acute ischemic stroke who were considered eligible and received thrombolysis at the participating stroke registries during the study period were included. All 9238 patients who received thrombolysis were included in this retrospective analysis.Main Outcomes and MeasuressICH was defined as clinical worsening of at least 4 points on the National Institutes of Health Stroke Scale (NIHSS), attributed to parenchymal hematoma, subarachnoid, or intraventricular hemorrhage. Differences between tenecteplase and alteplase in the risk of sICH were assessed using logistic regression, adjusted for age, sex, NIHSS score, and thrombectomy.ResultsOf the 9238 patients included in the analysis, the median (IQR) age was 71 (59-80) years, and 4449 patients (48%) were female. Tenecteplase was administered to 1925 patients. The tenecteplase group was older (median [IQR], 73 [61-81] years vs 70 [58-80] years; P &lt; .001), more likely to be male (1034 of 7313 [54%] vs 3755 of 1925 [51%]; P &lt; .01), had higher NIHSS scores (median [IQR], 9 [5-17] vs 7 [4-14]; P &lt; .001), and more frequently underwent endovascular thrombectomy (38% vs 20%; P &lt; .001). The proportion of patients with sICH was 1.8% for tenecteplase and 3.6% for alteplase (P &lt; .001), with an adjusted odds ratio (aOR) of 0.42 (95% CI, 0.30-0.58; P &lt; .01). Similar results were observed in both thrombectomy and nonthrombectomy subgroups.Conclusions and RelevanceIn this large study, ischemic stroke treatment with 0.25-mg/kg tenecteplase was associated with lower odds of sICH than treatment with alteplase. The results provide evidence supporting the safety of tenecteplase for stroke thrombolysis in real-world clinical practice.

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Switching to Tenecteplase for Stroke Thrombolysis

Cited by 43 publications

References 4 publications

Tenecteplase for Intravenous Thrombolysis of Ischemic Stroke: A Single MRI-based Comprehensive Stroke Center Experience

Tenecteplase for Intravenous Thrombolysis of Ischemic Stroke: A Single MRI-based Comprehensive Stroke Center Experience

Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke

Symptomatic Intracranial Hemorrhage With Tenecteplase vs Alteplase in Patients With Acute Ischemic Stroke

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