Hasse Adam, Korwek Kimberly, Guy Jeffrey, Poland Russell E
Clinical Services Group, HCA Healthcare, Nashville, TN, USA.
Hosp Pract (1995). 2025 Feb;53(1):2438592. doi: 10.1080/21548331.2024.2438592. Epub 2024 Dec 17.
Pharmacologic thrombolytic treatment for acute ischemic stroke has primarily been managed by intravenous alteplase. Tenecteplase is a variant that has been shown to be non-inferior to alteplase in clinical trials. In this study, we present a real-world assessment of patient outcomes with the facility-wide transition to the use of tenecteplase versus altepase for acute ischemic stroke in a large system of community hospitals in the United States.
This retrospective analysis assessed adult patients who received either alteplase or tenecteplase between 1 April 2020 and 31 March 2023. Propensity matching was used to estimate the covariate-adjusted association with outcomes of discharge expired/hospice, intracranial hemorrhage and readmission to a facility in the same healthcare system within 30, 60, or 90 days.
Among 12,766 patients, gross mortality was 7.6% ( = 285) with tenecteplase and 8.2% ( = 739) with alteplase ( = 0.314); intracranial hemorrhage was 2.4% with either. The propensity match analysis found that the relative risk of mortality/hospice for patients given tenecteplase versus alteplase was 0.993 (95% CI: 0.848-1.162, = 1.000). When limited to five facilities with the highest volume of thrombolytic use, there were no significant differences in outcomes. While the time from emergency department arrival to thrombolytic administration (door-to-needle) was shorter among patients receiving tenecteplase, there was no significant difference in the odds of mortality based on door-to-needle time.
In alignment with previous studies, these findings demonstrate the lack of potential harm with a transition from alteplase to tenecteplase in clinical practice for acute ischemic stroke patients treated in community hospitals.
急性缺血性卒中的药物溶栓治疗主要采用静脉注射阿替普酶。替奈普酶是一种变体，在临床试验中已被证明不劣于阿替普酶。在本研究中，我们对美国一个大型社区医院系统中急性缺血性卒中患者在全院范围内从使用阿替普酶转为使用替奈普酶后的患者结局进行了真实世界评估。
这项回顾性分析评估了2020年4月1日至2023年3月31日期间接受阿替普酶或替奈普酶治疗的成年患者。采用倾向匹配法估计与出院时死亡/临终关怀、颅内出血以及在30、60或90天内在同一医疗系统内再次入院结局的协变量调整关联。
在12766例患者中，使用替奈普酶的总死亡率为7.6%（n = 285），使用阿替普酶的为8.2%（n = 739）（P = 0.314）；两者的颅内出血率均为2.4%。倾向匹配分析发现，接受替奈普酶治疗的患者与接受阿替普酶治疗的患者相比，死亡/临终关怀的相对风险为0.993（95%CI：0.848 - 1.162，P = 1.000）。当仅限于溶栓使用量最高的五个机构时，结局无显著差异。虽然接受替奈普酶治疗的患者从急诊科就诊到溶栓给药（门到针）的时间较短，但基于门到针时间的死亡率几率无显著差异。
与先前的研究一致，这些发现表明，在社区医院治疗的急性缺血性卒中患者的临床实践中，从阿替普酶转为替奈普酶没有潜在危害。
