Key result
Tenecteplase for stroke thrombolysis was associated with greater odds of a favorable modified Rankin Scale score (0-2) compared to alteplase (adjusted OR 2.17; 95% CI 1.31-3.59).
Why the study?
Driven by practical advantages, growing trial safety data, recent guideline endorsement, and local needs, the authors switched from alteplase to tenecteplase for stroke thrombolysis and sought to describe the change process and real-world outcomes.
Does tenecteplase improve functional outcomes compared to alteplase in patients undergoing stroke thrombolysis?
Observational (n=838)
Yes
Does tenecteplase improve functional outcomes compared to alteplase in patients undergoing stroke thrombolysis?
A region-wide switch from alteplase to tenecteplase for stroke thrombolysis was associated with improved functional outcomes and shorter door-to-needle times without increased harm.
Answers are grounded in this paper and cite their sources.
May support tenecteplase preference in stroke thrombolysis; leaves open confirmation in randomized trials.
Background and Purpose: Due to practical advantages, increasing trial safety data, recent Australian Guideline endorsement and local population needs we switched to tenecteplase for stroke thrombolysis from alteplase. We describe our change process and real-world outcome data. Methods: Mixed-methods including stakeholder engagement, preimplementation and postimplementation surveys, and assessment of patient treatment rates, metrics, and clinical outcomes preimplementation and postimplementation adjusting regression analyses for age, sex, National Institutes of Health Stroke Scale, premorbid modified Rankin Scale score, and thrombectomy using New Zealand National Stroke Registry data. Results: Preswitch consultation involved stroke and emergency clinicians, pharmacists, national regulatory bodies, and hospital legal teams. All survey responders (90% response rate) supported the proposed change and remained satisfied 12 months postimplementation. Between January 2018 and February 2021, we treated 555 patients with alteplase and 283 with tenecteplase. Patients treated with tenecteplase had greater odds of a favorable modified Rankin Scale using both shift (adjusted odds ratio, 1.60 [95% CI, 1.15–2.22]) and dichotomous analyses (modified Rankin Scale score, 0–2; adjusted odds ratio, 2.17 [95% CI, 1.31–3.59]) and shorter median (interquartile range) door-to-needle time (median, 53 [38–73.5] versus 61 minutes [45–85], P=0.0002). Symptomatic intracranial hemorrhage rates (tenecteplase 1.8% versus 3.4%; adjusted odds ratio, 0.46 [95% CI, 0.13–1.64]), death by day 7 (tenecteplase 7.5% versus 11.8%; adjusted odds ratio, 0.46 [95% CI, 0.21–0.99]), and median (interquartile range) needle to groin time for the 42 transferred regional patients (tenecteplase 155 [113–248] versus 200 [158–266]; P=0.27) did not significantly differ. Conclusions: Following stakeholder endorsement, a region-wide switch from alteplase to tenecteplase was successfully implemented. We found evidence of benefit and no evidence of harm.
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Mahawish et al. (2021) conducted an observational in Stroke (n=838). Tenecteplase vs. Alteplase was evaluated on Favorable modified Rankin Scale score (0-2) (adjusted OR 2.17, 95% CI 1.31-3.59). Tenecteplase for stroke thrombolysis was associated with greater odds of a favorable modified Rankin Scale score (0-2) compared to alteplase (adjusted OR 2.17; 95% CI 1.31-3.59).
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