(699) Improved Door-to-Needle Time After Implementation of Tenecteplase for Acute Ischemic Stroke Patients

Introduction: Acute ischemic stroke is a leading cause of death and long-term disability due to loss of oxygenation to the brain. To improve patient outcomes, timely restoration of blood flow to the ischemic brain tissue is vital. One reperfusion strategy includes administration of thrombolytics. Historically, alteplase has been the thrombolytic of choice for acute ischemic stroke; however, given recent safety and efficacy data, tenecteplase has gained popularity due to its optimal pharmacokinetic profile. The purpose of this study is to describe the impact of tenecteplase as the preferred thrombolytic compared to alteplase in adult patients with acute ischemic stroke.

Methods: This single center, retrospective cohort study included adult patients who received intravenous thrombolytic therapy, either tenecteplase 0.25 mg/kg or alteplase 0.9mg/kg, from May 2021 to December 2023. The primary outcome was door-to-needle time. Secondary safety outcomes included incidence of symptomatic intracerebral hemorrhage (ICH), any ICH on 24-hour follow-up imaging, major extracranial bleeding, and angioedema. Secondary efficacy outcomes included discharge with a favorable neurological outcome, discharge disposition, ICU length of stay, and overall length of stay. Secondary stroke metric outcomes included door-to-computed tomography (CT) time, CT-to-needle time, neurologist notification-to-needle time, and thrombolytic decision-to-needle time.

Results: Fifty patients were included in the alteplase group and 50 patients were included in the tenecteplase group. The primary outcome, door-to-needle time, was significantly shorter in the tenecteplase group (36 vs. 30 minutes, p = 0.006). There were no statistically significant differences found in the secondary safety and efficacy outcomes. Patients that received tenecteplase experienced significantly faster CT-to-needle times (17 vs. 11 minutes, p = 0.006), neurologist notification-to-needle times (32 vs. 25 minutes, p = 0.001), and thrombolytic decision-to-needle times (9 vs. 5 minutes, p < 0.001).

Conclusions: In this retrospective, observational study, there was a statistically significant decrease in door-to-needle time with tenecteplase compared to alteplase. No significant differences in secondary safety and efficacy outcomes were observed.