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

Authors :
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
Source :
Neurology [Neurology] 2024 Apr 09; Vol. 102 (7), pp. e209166. Date of Electronic Publication: 2024 Mar 19.
Publication Year :
2024

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.<br />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.<br />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).<br />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.<br />Trial Registration Information: ClinicalTrials.gov Identifiers: NCT02388061, NCT03340493.<br />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.

Details

Language :
English
ISSN :
1526-632X
Volume :
102
Issue :
7
Database :
MEDLINE
Journal :
Neurology
Publication Type :
Academic Journal
Accession number :
38502892
Full Text :
https://doi.org/10.1212/WNL.0000000000209166