Monkemeyer Nicholas J, Marino Kaylee K, Goodberlet Melanie Z, Anderson Christopher, Bresette Linda, Webb Andrew J, Singhal Aneesh, Ware Lydia R
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Ann Pharmacother. 2025 Jun;59(6):538-548. doi: 10.1177/10600280241300230. Epub 2024 Nov 26.
Off-label tenecteplase use for acute ischemic stroke (AIS) has increased due to ease of administration and comparable efficacy and safety to alteplase.
This study aimed to evaluate time to thrombolysis before and after transition from alteplase to tenecteplase for treatment of AIS at 2 institutions.
This retrospective cohort study included adult patients receiving thrombolysis for AIS before and after transition from alteplase to tenecteplase at 2 academic medical centers from January 1, 2020 to January 31, 2024. The primary endpoint was door-to-needle (DTN) time, defined as minutes from hospital arrival to thrombolysis administration. Notable secondary endpoints included time from last known well (LKW) to thrombolysis, time from brain imaging to thrombolysis, hospital length of stay (LOS), and incidence of symptomatic intracranial hemorrhage (sICH).
A total of 328 patients (168 tenecteplase and 160 alteplase) were included. Patients were 51.5% female with a median (interquartile range [IQR]) age of 70 [58-80] years and initial National Institutes of Health Stroke Scale (NIHSS) score of 8 [5-14]. There was no statistically significant difference in DTN time (60 vs 56 minutes), time from LKW to thrombolysis (134 vs 147.5 minutes), or time from brain imaging to thrombolysis (32 vs 31 minutes) between tenecteplase and alteplase. Hospital LOS (5.7 vs 4.9 days) and the rates of sICH (3% vs 3.8%) were similar between groups.
Tenecteplase and alteplase had comparable DTN times for treatment of AIS and similar safety endpoints. Further studies are warranted to identify opportunities to streamline DTN times with tenecteplase.
由于给药方便且与阿替普酶具有相当的疗效和安全性，替奈普酶在急性缺血性卒中（AIS）的超说明书使用有所增加。
本研究旨在评估在两家机构中，从阿替普酶转换为替奈普酶治疗AIS前后的溶栓时间。
这项回顾性队列研究纳入了2020年1月1日至2024年1月31日期间在两家学术医疗中心从阿替普酶转换为替奈普酶前后接受AIS溶栓治疗的成年患者。主要终点是门到针（DTN）时间，定义为从医院入院到溶栓给药的分钟数。值得注意的次要终点包括从最后已知正常（LKW）到溶栓的时间、从脑部成像到溶栓的时间、住院时间（LOS）以及症状性颅内出血（sICH）的发生率。
共纳入328例患者（168例使用替奈普酶和160例使用阿替普酶）。患者中51.5%为女性，中位（四分位间距[IQR]）年龄为70[58 - 80]岁，初始美国国立卫生研究院卒中量表（NIHSS）评分为8[5 - 14]。替奈普酶和阿替普酶在DTN时间（60分钟对56分钟）、从LKW到溶栓的时间（134分钟对147.5分钟）或从脑部成像到溶栓的时间（32分钟对31分钟）方面无统计学显著差异。两组之间的住院时间（5.7天对4.9天）和sICH发生率（3%对3.8%）相似。
替奈普酶和阿替普酶在治疗AIS时具有相当的DTN时间和相似的安全性终点。有必要进行进一步研究以确定利用替奈普酶简化DTN时间的机会。
