Association of Time to Thrombolysis With Early Reperfusion After Alteplase and Tenecteplase in Patients With Large Vessel Occlusion

Yogendrakumar, V; Beharry, J; Churilov, L; Pesavento, L; Alidin, K; Ugalde, M; Weir, L; Mitchell, PJ; Kleinig, TJ; Yassi, N; Thijs, VN; Wu, TY; BROWN, H; Dewey, HM; Wijeratne, T; Yan, B; Sharma, GJ; Desmond, P; Parsons, MW; Donnan, GA; Davis, SM; Campbell, BCV

Author(s): Yogendrakumar, V; Beharry, J; Churilov, L; Pesavento, L; Alidin, K; Ugalde, M; Weir, L; Mitchell, PJ; Kleinig, TJ; Yassi, N; Thijs, VN; Wu, TY; BROWN, H; Dewey, HM; Wijeratne, T; Yan, B; Sharma, GJ; Desmond, P; Parsons, MW; Donnan, GA; Davis, SM; Campbell, BCV;
Details: Publication Year 2024-04-09,Volume 102,Issue #7,Page e209166
Journal Title: Neurology
Abstract: BACKGROUND AND OBJECTIVES: Early treatment with intravenous alteplase increases the probability of lytic-induced reperfusion in large vessel occlusion (LVO) patients. The relationship of tenecteplase-induced reperfusion and the timing of thrombolytic administration has not been explored. In this study, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates and assessed their relationship to the time of thrombolytic administration. METHODS: Patients who were initially treated with a thrombolytic within 4.5 hours of symptom onset were pooled from the Royal Melbourne Stroke Registry, EXTEND-IA, EXTEND-IA TNK, and EXTEND-IA TNK part 2 trials. The primary outcome, thrombolytic-induced reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion at initial angiographic assessment (or repeat CT perfusion/angiography). We compared the treatment effect of tenecteplase and alteplase through fixed-effects Poisson regression modelling. RESULTS: Among 846 patients included in the primary analysis, early reperfusion was observed in 173 (20%) patients (tenecteplase: 98/470 [21%], onset-to-thrombolytic time: 132 minutes [interquartile range (IQR): 99-170], and thrombolytic-to-assessment time: 61 minutes [IQR: 39-96]; alteplase: 75/376 [19%], onset-to-thrombolytic time: 143 minutes [IQR: 105-180], thrombolytic-to-assessment time: 92 minutes [IQR: 63-144]). Earlier onset-to-thrombolytic administration times were associated with an increased probability of thrombolytic-induced reperfusion in patients treated with either tenecteplase (adjusted risk ratio [aRR] 1.05 per 15 minutes [95% confidence interval (CI) 1.00-1.12] or alteplase (aRR 1.06 per 15 minutes [95% CI 1.00-1.13]). Tenecteplase remained associated with higher rates of reperfusion vs alteplase after adjustment for onset-to-thrombolytic time, occlusion site, thrombolytic-to-assessment time, and study as a fixed effect, (adjusted incidence rate ratio: 1.41 [95% CI 1.02-1.93]). No significant treatment-by-time interaction was observed (p = 0.87). DISCUSSION: In patients with LVO presenting within 4.5 hours of symptom onset, earlier thrombolytic administration increased successful reperfusion rates. Compared with alteplase, tenecteplase was associated with a higher probability of lytic-induced reperfusion, independent of onset-to-lytic administration times. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifiers: NCT02388061, NCT03340493. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that among patients with LVO receiving a thrombolytic, reperfusion was more likely with tenecteplase than alteplase.
Publisher: AAN
Research Division(s): Population Health And Immunity
PubMed ID: 38502892
Publisher's Version: https://doi.org/10.1212/wnl.0000000000209166
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-03-27 08:35:47

Last Modified: 2024-03-27 08:50:02