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. 2023 Dec;8(4):942-946.
doi: 10.1177/23969873231187436. Epub 2023 Jul 25.

Tenecteplase real-world data: A three phase sequential comparison

Anna Ranta  1   2 , Alicia Tyson  1 , Bhavesh Lallu  3 , Teddy Y Wu  4 , Martin Punter  1   2 , Csilla Manoczki  1 , John Chalissery  3 , Akesh Pillai  5 , Karim Mahawish  6 , Roldan Conde  7 , Marianne Falconer  8 , Karyn Wills  9 , Chaminda Gunawardana  6 , Suzanne Busch  7 , John Gommans  9
Affiliations

Tenecteplase real-world data: A three phase sequential comparison

Anna Ranta et al. Eur Stroke J. 2023 Dec.

Abstract

Introduction: The New Zealand (NZ) Central Region Stroke Network, serving 1.17 million catchment population, changed to tenecteplase for stroke thrombolysis in 2020 but was forced to revert to Alteplase in 2021 due to a sudden cessation of drug supply. We used this unique opportunity to assess for potential before and after temporal trend confounding.

Patients and methods: In NZ all reperfused patients are entered prospectively into a national database for safety monitoring. We assessed Central Region patient outcomes and treatment metrics over three time periods: alteplase use (January 2018-January 2020); during switch to tenecteplase (February 2020-February 2021) and after reverting to alteplase (February 2021-December 2022) adjusting regression analyses for hospital, age, onset-to-needle, NIHSS, pre-morbid mRS and thrombectomy.

Results: Between January 2018 and December 2022, we treated 1121 patients with Alteplase and 286 with tenecteplase. Overall, patients treated with tenecteplase had greater odds of favorable outcome ordinal mRS [aOR = 1.43 (95% CI = 1.11-1.85)]; shorter door-to-needle (DTN) time [median 52 (IQR 47-83) vs 61 (45-84) minutes, p < 0.0001] and needle to groin (NTG) times [118 (74.5-218.5) vs 185 (118-255); p = 0.02)]. Symptomatic intracerebral hemorrhage (sICH) rate was lower in tenecteplase group [aOR 0.29 (0.09-0.95)]. Findings similarly favored tenecteplase when comparing tenecteplase to only the second alteplase phase. There was no inter-group difference when comparing the two alteplase phases.

Conclusions: Our results suggest that previously reported benefits from tenecteplase in a real-world setting were not likely attributable to a temporal confounding.

Keywords: Stroke; reperfusion; tenecteplase; thrombolysis.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Door-to-Needle and Groin times by phase; overall and for non-thrombectomy centers.
See this image and copyright information in PMC

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