Prospective Observational Cohort Study Of Tenecteplase Versus Alteplase In Routine Clinical Practice

• DOI: 10.1101/2022.07.12.22277564
• Publication Date: 2022-07-15T16:10:18Z
• Authors: Steven J Warach; Adrienne N Dula; Truman J Milling; Samantha Miller; Leigh Allen; Nathan D Zuck; Collin Miller; Christine A Jesser; Lotika R Misra; Jefferson T Miley; Manzure Mawla; Ming-Chieh Ding; John A Bertelson; Annie Y Tsui; John R Jefferson; Holly M Davison; Darshan N Shah; Matthew M Padrick; Alan S. Nova; Kent T Ellington; Vivek R Krishna; Lisa A Davis; David Paydarfar
• Keywords: Tenecteplase; Clinical Practice

ABSTRACT Background and Purpose A 10-hospital regional network transitioned to tenecteplase as the standard of care stroke thrombolytic in September 2019 because its workflow advantages reported non-inferior clinical outcomes relative alteplase meta-analyses randomized trials. We assessed whether use routine practice reduces times with outcomes. Methods designed a prospective registry-based observational, sequential cohort comparison (n=234) (n=354) treated patients. hypothesized: (1) an increase proportion patients meeting target for door needle (DTN) transfer door-in-door-out (DIDO), (2) favorable (discharge home independent ambulation) unfavorable (symptomatic intracranial hemorrhage, in-hospital mortality or discharge hospice) group. Total hospital cost associated each treatment was also compared. Results Target DTN within 45 minutes superior tenecteplase, 41% versus 29%; aOR 1.76 (95% CI 1.24, 2.52), P = 0.002. DIDO 90 37% (15/43) 14% (9/65); OR 3.69 1.47, 9.7), =0.006, overall, 67% (12/18) (2/14) those transferred thrombectomy after ( =0.009). Favorable outcome fell 6.5% non-inferiority margin; 1.28 0.92, 1.77). Unfavorable less 7.7% 11.9%, 0.79 0.46, 1.32), but did not fall pre-specified 1% boundary. Net benefit (%favorable – %unfavorable) greater sample: 36% v 27%. =0.022. Median per encounter cases ($13,382 vs $15,841; <0.001). Conclusions Switching shorter times, at discharge, reduced costs. Evaluation larger, multicenter cohorts is recommended determine if these observations generalize.