The new generation of clot-busting drugs outperforms conventional stroke treatment in many areas

A new study published today in the American Stroke Association’s Journal shows that a new generation of clot-busting drugs called tenecteplase outperform conventional treatment for ischemic strokes in several key areas, including better health outcomes and lower costs. brain attack.

The study was led by a team of neurologists at the University of Texas Dell Medical School in Austin and was conducted over 15 months at 10 Ascension Seton Hospitals in Central Texas starting in September 2019.

Dell Med Neurology Stroke was one of the first programs in the United States to make this change. Based on the early results of this study, other experts across the country were convinced and made the switch from alteplase to tenecteplase at their own stroke centers, including Ascension hospitals across the country.”

Stephen Warach, MD, lead author of the study and director of the Stroke Program at Dell Med and Ascension Texas

Approximately 800,000 people in the United States have a stroke each year. The vast majority of these strokes (about 87%) are ischemic, which means that they occur when one of the blood vessels that supply blood to the brain is obstructed by a blood clot. This can lead to a similar loss of neurological function.

Both tenecteplase and alteplase are federally approved for use in dissolving clots in blocked heart arteries. But the newer drug tenecteplase is also used by doctors, off-label, to treat strokes, because clinical trials in stroke suggest that it may be at least as good as alteplase and easier to administer. Tenecteplase is administered as a single intravenous injection of five to 10 seconds duration. The researchers compared its performance with the standard stroke drug, alteplase, which is injected over 60 minutes.

“When it comes to treating patients who have had a stroke, every second counts,” said Warach, who is also a professor of neuroscience at Dell Med. “The shorter preparation and injection time with tenecteplase not only eliminates many of the dosing errors related to alteplase, but is also more efficient. We were able to deliver clot-busting medication more quickly after patients arrived in the emergency department, and for patients who needed to be transferred to another hospital for treatment. On more advanced care after they received the anticoagulant, we were able to start transfusion sooner in those treated with tenecteplase.”

For patients who come to the emergency department after a stroke, the Warach study found “door-to-needle” time -; time between patients’ arrival and the moment they receive treatment -; It was on average six minutes faster with tenecteplase. For patients who also required thrombectomy, that is, surgical removal of the blood clot causing the stroke, tenecteplase may speed up the process of transporting the patient to a stroke center capable of thrombectomy for 25 minutes.

The researchers also noted improvements in clinical outcomes for patients who were given tenecteplase, including:

  • 5% increase in the number of patients who were able to walk independently at the time of hospital discharge home.
  • 4% reduction in the incidence of adverse events such as brain hemorrhage, discharges for hospice care or death.

The third major improvement: cost. The research team found that tenecteplase treatment costs hospitals about $2,500 less than alteplase per patient.

“If this price differential persists, the amount of savings could equate to upwards of $150 million annually in the United States,” said David Paydarfar, MD, study director and chief of neurology at Dell Med. “This is a great example of value-based care; better care for less money.”

The Dell Med Neurology Stroke Program is now working with colleagues in the state-funded Lone Star Stroke Research Consortium to spread the results of its study across the state, helping more stroke centers switch to tenecteplase. Warach is also working with fellow Lone Star Stroke to build a statewide database to confirm their findings and answer outstanding questions.

“For example, we have such a large Hispanic population in Texas. I’d like to know if we see the same advantages from tenecteplase in this community as we do in a larger population,” Warach said. “The more data we have, the more questions we can answer.”


Journal reference:

Warach, S. J., et al. (2022) A prospective observational cohort study of tenectyplase versus alteplase in routine clinical practice. brain attack.