Outcomes with IV tenecteplase and IV alteplase for acute ischemic stroke with or without thrombectomy in real-world settings in the United States |
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| Institution: | 1. Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, MO, USA;2. Institute for Data Science and Informatics, University of Missouri, MO, USA;3. Division of Neurosurgery, University of Missouri, Columbia, MO, USA;4. Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA;1. Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan;2. Department of Neurosurgery, Maebashi Neurosurgical Clinic, Maebashi, Gunma, Japan;1. Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China;2. LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada;3. Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada;4. Department of Medical Biophysics, University of Toronto, Ontario, Canada;5. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA;6. Hauenstein Neuroscience Center, Saint Mary''s Health Care, Grand Rapids, MI, USA;7. LCC International University;8. Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada;1. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan;2. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan;1. Department of Cardiovascular Surgery, University of Health Sciences, Bagcilar Training and Research Hospital, ?stanbul, Turkey;2. Department of Cardiovascular Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, ?stanbul, Turkey;3. Department of Cardiology, University of Health Sciences, Bagcilar Training and Research Hospital, ?stanbul, Turkey;1. School of Medicine, New York Medical College, Valhalla, NY, United States;2. Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States;3. Department of Neurology, University of South Carolina/PRISMA Health Richland, Columbia, SC, United States;4. Department of Neurosurgery, University of New Mexico, Albuquerque, NM, United States;1. Department of Neurology, St George''s University Hospital, UK;2. Department of Research and Development, The Royal United Hospitals Bath NHS Foundation Trust, UK;3. Department of Stroke Medicine, Imperial College Healthcare NHS Trust, UK;4. Department of Neurology, Affiliated Hospital of Nantong University, China;5. Department of Neuroradiology, St George''s University Hospital, UK;6. Imaging Department, Imperial College Healthcare NHS Trust, UK;7. Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, UK;8. Department of Vascular Surgery, St George''s University Hospital, UK;9. Department of Clinical Neuroscience, University of Cambridge, UK;10. Department of Radiology, University of Calgary |
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| Abstract: | Background and PurposeAlthough many stroke centers in United States are using intravenous (IV) tenecteplase (TNK) for acute ischemic stroke patients, there is paucity of comparative data between IV TNK and IV alteplase from real-world settings.Materials and MethodsWe analyzed the data from 122 healthcare facilities in Cerner Real World Data and included patients admitted between February 2016 to April 2022 to determine the effect of IV TNK (compared with IV alteplase) on occurrence of two outcomes in acute ischemic stroke patients stratified by use of thrombectomy: non-routine discharge or death, and intracranial hemorrhage after adjusting for potential confounders.ResultsAmong 30,643 acute ischemic stroke patients analyzed, 29,480 (96.2%) and 1,163 (3.8%) patients received IV alteplase and IV TNK, respectively. The proportion of patients who received thrombectomy was significantly higher among patients who received IV TNK compared with those who received IV alteplase (16.7% versus 11.0%, p<0.001). Occurrence of intracranial hemorrhage was more common among patients treated with IV TNK in acute ischemic stroke patients who did not receive thrombectomy (7.9% versus 5.1%, p<0.001) but not in those who received thrombectomy (20.1% versus 16.8%, p = 0.234). In the logistic regression analysis, patients treated with IV TNK who did not receive thrombectomy were at higher risk of intracranial hemorrhage (OR, 1.34, 95% CI 1.05-1.72, p = 0.02) after adjusting for age (age strata), gender, race/ethnicity, hypertension, diabetes mellitus, atrial fibrillation, hyperlipidemia, malignancy, nicotine dependence, previous ischemic stroke, previous transient ischemic attack, previous intracerebral hemorrhage, previous subarachnoid hemorrhage, previous acute myocardial infarction, atherosclerosis of aorta, previous AKI, congestive heart failure, peripheral vascular disease, and hospital type, aphasia, hemiplegia, neglect, somnolence, stupor and coma, dysphagia, and homonymous hemianopsia. There was no difference in the rate of non-routine discharge or death between patients treated with IV TNK and those treated with IV alteplase in the multivariate analyses.ConclusionsIn an analysis of real-world data, IV TNK was associated with higher rates of intracranial hemorrhage compared with IV alteplase in patients with acute ischemic stroke who did not undergo thrombectomy. |
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