Τίτλος:
Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background and aims: Tenecteplase has recently emerged as an alternative thrombolytic agent in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO), possibly superior in achieving early reperfusion compared with alteplase. We aimed to compare the safety and efficacy of intravenous tenecteplase with intravenous alteplase for AIS patients with LVO in everyday clinical practice settings. Methods: We prospectively evaluated patients with AIS due to LVO, treated with intravenous thrombolysis (IVT) with or without mechanical thrombectomy in two tertiary stroke centers. Patients were treated with standard-dose alteplase (0.9 mg/kg) or 0.25 mg/kg tenecteplase. Safety outcomes included prevalence of symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes included averted thrombectomy, major neurological improvement at 24 h (defined as decrease in baseline NIHSS score of 8 points or greater) and functional status on discharge and on 3 months assessed by modified Rankin Scale (mRS). Results: Nineteen AIS patients with LVO received tenecteplase and 39 received alteplase. We observed a non-significant higher rate of averted thrombectomies (32% versus 18%, p = 0.243) and a non-significant higher rate of sICH (16% versus 5%, p = 0.201) in the tenecteplase group. The rate of 24 h major neurological improvement was higher in the tenecteplase group (64% versus 33%, p = 0.046) but this was marginally attenuated in multivariable analyses (adjusted OR 10.22, 95% CI: 0.73–142.98; p = 0.084). Discharge mRS, 3-months mRS, and 3-month functional independence (mRS scores of 0–2) did not differ (p > 0.2) between the two groups. The rates of 3-month mortality (11% versus 18%, p = 0.703) were similar in the two groups. No independent association between thrombolytic agent and safety or efficacy outcomes emerged in multivariable regression analyses. Conclusion: The present pilot observational study highlights that AIS patients with LVO treated with 0.25 mg/kg bolus administration of tenecteplase had increased likelihood to achieve early neurological improvement compared with AIS patients treated with alteplase, but this association was attenuated after adjustment for potential confounders. There were no significant differences in 3-month functional or safety outcomes between the two groups. This preliminary real-world observation requires independent confirmation in larger, multicenter studies. © The Author(s), 2021.
Συγγραφείς:
Psychogios, K.
Palaiodimou, L.
Katsanos, A.H.
Magoufis, G.
Safouris, A.
Kargiotis, O.
Spiliopoulos, S.
Papageorgiou, E.
Theodorou, A.
Voumvourakis, K.
Broutzos, E.
Stamboulis, E.
Tsivgoulis, G.
Περιοδικό:
Therapeutic Advances in Neurological Disorders
Εκδότης:
SAGE Publications Ltd
Λέξεις-κλειδιά:
alteplase; low density lipoprotein; tenecteplase, activated partial thromboplastin time; aged; Article; basilar artery; blood vessel occlusion; brain blood flow; brain hemorrhage; brain infarction; brain ischemia; clinical assessment; clinical evaluation; clinical practice; cohort analysis; computed tomographic angiography; congestive heart failure; digital subtraction angiography; drug efficacy; drug safety; female; follow up; functional status; hemodynamics; hospitalization; human; intensive care unit; internal carotid artery; magnetic resonance angiography; major clinical study; male; mechanical thrombectomy; middle cerebral artery occlusion; mortality; National Institutes of Health Stroke Scale; neuroimaging; neuroradiologist; nuclear magnetic resonance imaging; observational study; pilot study; prevalence; prospective study; Rankin scale; recanalization; reperfusion; stroke patient; susceptibility weighted imaging; thrombectomy
DOI:
10.1177/1756286420986727
