ANA Investigates: Tenecteplase

It may be that the landscape of stroke care is changing, as more attention being drawn to benefits intravenous (IV) tenecteplase for acute reperfusion therapy, particularly given ease administration and affordability highlighted by COVID-19 pandemic. The latest ANA Investigates podcast asks Professor Bruce Campbell important questions about body evidence surrounding tenecteplase, including whether it superior IV alteplase, current drug used an thrombolytic. Dr provides his expertise a researcher in this area co–principal investigator EXTEND-IA TNK (tenecteplase) multicenter randomized clinical trials. Since 1995 National Institute Neurological Disorders Stroke trial cited 30% chance minimal disability at 90 days symptomatic intracerebral hemorrhage (sICH) rate 6.4%, alteplase has been routinely administered eligible patients.1 Tenecteplase differences when compared alteplase. discusses naturally occurring our blood and, patients, helps activate plasminogen, which turns into plasmin, then acts break down clot. genetically modified form with only 3 amino acids distinguishing two molecules. This modification increases half-life 22 minutes, approximately minutes. As result, does not have drip infusion over hour case alteplase; rather, can bolus 5 seconds. These changes its structure also make specific clot resistant breakdown bloodstream.2, From economic perspective, cost savings could substantial. points out that, outside United States, patients weighing than 55kg require 2 vials so switching represent 50% savings. In he estimates replacing save $3,000 per treatment.4 When considering risks medication, sICH risk angioedema appear similar those however, data are limited, medication use widespread. highlights treatment currently off label. follow package insert dosing instructions, relate on-label indication myocardial infarction. dose half infarction, no adjunctive heparin or antiplatelet agents used. Johansen turn practice practicality tenecteplase. trials incorporated different doses5 most discussed 0.1mg/kg, 0.25mg/kg, 0.4mg/kg. summarizes literature, Australian suggested superiority 0.25mg/kg 0.1mg/kg large vessel occlusion (who were treated prior availability endovascular thrombectomy).6 There did benefit increasing from 0.40mg/kg own part trial,7 earlier suggesting increased risk,5 although later always supported concern.8 research demonstrating among who received they saw doubling 10% 20% occlusion, well shift functional patients.7, 9 Registry basilar artery potentially one deadly types suggest tenecteplase.10 describes experience Australia, where now recommended guidelines alternative occlusion. Some systems such telemedicine service state Victoria switched entirely He emphasizes importance protocol, rationale some institutions was maintaining thrombolytic options doses created substantial risk. Beyond 4.5-hour window, limited. Prior enroll beyond 4.5 hours, but test time window specifically.6 support thrombolysis hours based on alteplase.11, 12 Similar using ongoing. states Australian13 European Guidelines14 include recommendations 4.5- 9-hour wake-up computed tomography magnetic resonance imaging (MRI) perfusion mismatch, selection thrombectomy 6 24 after onset. American Heart Association (AHA) assessed these yet, there AHA, European, MRI fluid-attenuated inversion recovery–diffusion mismatch select unknown onset Upon asked sufficient actually available implemented stroke. However, completing ongoing TASTE, ATTEST-2, AcT, NORTEST-2 0 onset, predominantly without occlusion; TIMELESS ETERNAL-LVO hours; TEMPO-2 utilizing nondisabling symptoms lesion, results PRISMS show benefit.15 anticipates will continue play role ischemic future combined other medications address components thrombus. Link: https://traffic.libsyn.com/secure/myana/S2_Ep5_ANA_Investigates_Tenecteplase_in_Stroke.mp3 M.C.J. conceptualized episode, crafted questions, conducted interview, drafted summary manuscript. B.C.V.C. reviewed interview content, provided subject expertise, assisted manuscript editing. Nothing report.