Prospective Observational Cohort Study of Tenecteplase Versus Alteplase in Routine Clinical Practice.

Humans Brain Ischemia / drug therapy Fibrinolytic Agents / therapeutic use Stroke / drug therapy Tenecteplase / therapeutic use Tissue Plasminogen Activator / therapeutic use Treatment Outcome
hospital ischemic stroke morbidity standard of care tenecteplase

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
12 2022
Historique:
pubmed: 24 9 2022
medline: 1 12 2022
entrez: 23 9 2022
Statut: ppublish

Résumé

A 10-hospital regional network transitioned to tenecteplase as the standard of care stroke thrombolytic in September 2019 because of potential workflow advantages and reported noninferior clinical outcomes relative to alteplase in meta-analyses of randomized trials. We assessed whether tenecteplase use in routine clinical practice reduced thrombolytic workflow times with noninferior clinical outcomes. We designed a prospective registry-based observational, sequential cohort comparison of tenecteplase- (n=234) to alteplase-treated (n=354) stroke patients. We hypothesized: (1) an increase in the proportion of patients meeting target times for target door-to-needle time and transfer door-in-door-out time, and (2) noninferior favorable (discharge to home with independent ambulation) and unfavorable (symptomatic intracranial hemorrhage, in-hospital mortality or discharge to hospice) in the tenecteplase group. Total hospital cost associated with each treatment was also compared. Target door-to-needle time within 45 minutes for all patients was superior for tenecteplase, 41% versus 29%; adjusted odds ratio, 1.85 (95% CI, 1.27-2.71); Switching to tenecteplase in routine clinical practice in a 10-hospital network was associated with shorter door-to-needle time and door-in-door-out times, noninferior favorable clinical outcomes at discharge, and reduced hospital costs. Evaluation in larger, multicenter cohorts is recommended to determine if these observations generalize.

Sections du résumé

BACKGROUND
A 10-hospital regional network transitioned to tenecteplase as the standard of care stroke thrombolytic in September 2019 because of potential workflow advantages and reported noninferior clinical outcomes relative to alteplase in meta-analyses of randomized trials. We assessed whether tenecteplase use in routine clinical practice reduced thrombolytic workflow times with noninferior clinical outcomes.
METHODS
We designed a prospective registry-based observational, sequential cohort comparison of tenecteplase- (n=234) to alteplase-treated (n=354) stroke patients. We hypothesized: (1) an increase in the proportion of patients meeting target times for target door-to-needle time and transfer door-in-door-out time, and (2) noninferior favorable (discharge to home with independent ambulation) and unfavorable (symptomatic intracranial hemorrhage, in-hospital mortality or discharge to hospice) in the tenecteplase group. Total hospital cost associated with each treatment was also compared.
RESULTS
Target door-to-needle time within 45 minutes for all patients was superior for tenecteplase, 41% versus 29%; adjusted odds ratio, 1.85 (95% CI, 1.27-2.71);
CONCLUSIONS
Switching to tenecteplase in routine clinical practice in a 10-hospital network was associated with shorter door-to-needle time and door-in-door-out times, noninferior favorable clinical outcomes at discharge, and reduced hospital costs. Evaluation in larger, multicenter cohorts is recommended to determine if these observations generalize.

Identifiants

DOI: 10.1161/STROKEAHA.122.038950 PMID: 36148657
pubmed: 36148657
doi: 10.1161/STROKEAHA.122.038950
doi:

Substances chimiques

Fibrinolytic Agents 0
Tenecteplase WGD229O42W
Tissue Plasminogen Activator EC 3.4.21.68

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

3583-3593

Auteurs

Steven J Warach (SJ)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0003-3125-7979

Adrienne N Dula (AN)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
ORCID: 0000-0002-4809-6115

Truman J Milling (TJ)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0002-5588-0426

Samantha Miller (S)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Leigh Allen (L)

Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Nathan D Zuck (ND)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
ORCID: 0000-0001-5921-9128

Collin Miller (C)

Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Christine A Jesser (CA)

Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0002-7986-9184

Lotika R Misra (LR)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Jefferson T Miley (JT)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Manzure Mawla (M)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Ming-Chieh Ding (MC)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0002-2278-5326

John A Bertelson (JA)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Annie Y Tsui (AY)

Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

John R Jefferson (JR)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Holly M Davison (HM)

Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0002-6302-0717

Darshan N Shah (DN)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
ORCID: 0000-0002-7556-5802

Kent T Ellington (KT)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0001-8660-8778

Matthew M Padrick (MM)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).
ORCID: 0000-0002-1643-3674

Alan S Nova (AS)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Vivek R Krishna (VR)

Ascension Healthcare, Austin, TX (S.J.W., T.J.M., S.M., L.A., C.M., C.A.J., L.R.M., J.T.M., M.M., M.C.D., J.A.B., A.Y.T., J.R.J., H.M.D., D.N.S., K.T.E., M.M.P., A.S.N., V.R.K.).

Lisa A Davis (LA)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
ORCID: 0000-0001-5087-5612

David Paydarfar (D)

Department of Neurology, Dell Medical School, University of Texas at Austin (S.J.W., A.N.D., T.J.M., S.M., N.D.Z., L.R.M., J.T.M., M.M., M.C.D., J.A.B., J.R.J., D.N.S., K.T.E., M.M.P., A.S.N., L.A.D., D.P.).
ORCID: 0000-0002-3244-8104

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prospective Observational Cohort Study of...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Prospective Observational Cohort Study of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Fibrinolytiques › Prospective Observational Cohort Study of...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Prospective Observational Cohort Study of...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines du sang › Activateurs du plasminogène › Ténectéplase › Prospective Observational Cohort Study of...
questionsmedicales.fr › Facteurs biologiques › Facteurs de la coagulation sanguine › Activateur tissulaire du plasminogène › Prospective Observational Cohort Study of...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Prospective Observational Cohort Study of...