Mary Walton, PharmD
Critical Care Pharmacist
n/a
Knoxville, Tennessee
Disclosure information not submitted.
Leslie Hamilton, BCCCP, BCPS, PharmD
Associate Professor
University of Tennessee College of Pharmacy
Knoxville, Tennessee
Disclosure information not submitted.
Sonia Kennedy, BS
Pharmacy Student
University of Tennessee Health Sciences Center, United States
Disclosure information not submitted.
Brian Wiseman, MD
Vice President, Brain & Spine Institute
University of Tennessee Medical Center, United States
Disclosure information not submitted.
Mary Walton, PharmD
Critical Care Pharmacist
n/a
Knoxville, Tennessee
Disclosure information not submitted.
Shaun Rowe, PharmD, MS, BCCCP, FNCS
Associate Professor
University of Tennessee College of Pharmacy, United States
Disclosure information not submitted.
Title: Major Bleeding of Tenecteplase versus Alteplase in Acute Ischemic Stroke
INTRODUCTION/HYPOTHESIS: Tenecteplase (TNK) is a genetically engineered fibrinolytic with growing interest in the treatment of acute ischemic stroke. Compared to alteplase (TPA), TNK is as effective for neurologic improvement following ischemic stroke. The purpose of this study is to determine if major bleeding is significantly different in patients receiving TNK and TPA for acute ischemic stroke regardless of eligibility for mechanical thrombectomy or presence of large vessel occlusion.
Methods: This retrospective cohort reviewed all patients who received TPA or TNK for acute ischemic stroke from July 2016 to December 2020. Patients admitted before April 28, 2020, received TPA as an intravenous (IV) bolus over one minute followed by an infusion over one hour, for a total of 0.9 mg/kg. Patients admitted after this date received TNK 0.25 mg/kg as an IV bolus over five seconds. Any patient transferring from an outside facility was excluded.
Results: A total of 178 patients were included in the TPA group and 116 in the TNK group. There was no significant difference in major bleeding between TPA and TNK [45 (25%) vs. 20 (17%), p=0.104]. When adjusting for potential confounders between TPA and TNK, there were no variables associated with major bleeding in a multivariate logistic regression. As compared to patients who received TNK, patients who received TPA had a longer hospital length of stay (6 days [4,10] vs. 4 days [3,7], p=< 0.0001). There was no significant difference in all-cause inpatient mortality for TPA vs. TNK [16 (9%) vs. 5 (4%), p=0.128) or in adverse events between the groups [18 (10%) vs. 14 (12%), p=0.599] for TPA and TNK, respectively.
Conclusions: Tenecteplase had similar rates of major bleeding versus alteplase in the treatment of acute ischemic stroke.