In comparison with the usual clot-busting drug alteplase, the newer clot-busting drug tenecteplase may provide a secure, effective and simpler treatment for ischemic (clot-caused) stroke in mobile stroke units, in line with real-world experience detailed in a preliminary study to be presented on the 2024 International Stroke Conference organized by the American Stroke Association. The meeting will happen in Phoenix on February 7-9 and is the world’s most significant meeting for researchers and clinicians involved in stroke science and brain health.

Each tenecteplase and alteplase are clot-busting drugs. Nevertheless, tenecteplase is given as a single injection into the bloodstream, while alteplase requires an hour-long infusion after the primary injection. Alteplase is currently the one FDA-approved clot-busting drug used to treat ischemic stroke. Tenecteplase is approved by the FDA for the treatment of clots blocking coronary arteries and is used off-label to treat ischemic stroke.

One of the essential parts of treating stroke patients is getting them the medication they need as quickly and safely as possible. We all know from a recent large randomized trial that tenecteplase is simpler in treating stroke when given in an imaging-capable ambulance, but these results haven’t been confirmed outside the trial. In our study, we checked out the real-world use of tenecteplase and located that we were in a position to administer it without delays and make sure that our stroke patients received secure care as quickly as possible in our mobile stroke unit.”

J. Tyler Haller, Pharm. D., lead creator of the study and clinical pharmacy specialist in neurocritical care at St. John’s Hospital. Joseph and Medical Center in Phoenix

Barrow Neurological Institute in Phoenix has Arizona’s only mobile stroke unit, a specially equipped and staffed mobile emergency room. It’s used when fire department dispatchers determine that a 911 call indicates a possible stroke patient. The mobile stroke unit is staffed by stroke-certified staff and is provided with a CT scanner, a transportable laboratory and clot-busting medications to assist quickly diagnose and treat stroke.

For this study, researchers analyzed the electronic medical records of people that received clot-busting drugs in a mobile stroke unit between February 2021 and April 2023. The study analyzed the medical records of people that received treatment each before and after a mobile stroke. in May 2022, the treatment was modified from alteplase to tenecteplase. Through the study period, 40 participants received alteplase and 32 participants received tenecteplase. The median age of participants was 66 years and the mean National Institutes of Health Stroke Scale rating was 9, indicating a moderately severe stroke.

The study showed:

• There was no significant difference within the time between the patient’s admission to the mobile stroke unit and the administration of any of the clot-busting drugs.
• There was no difference in time from: entry to imaging results; dispatching a medicine administration unit; or a physician’s decision to treat until medication is run.
• As an indicator of safety, the researchers compared the speed of bleeding within the brain in patients inside 24 hours of receiving the clot-busting drug: no patients receiving either drug experienced this complication.

“Although there was no significant difference within the timing of administration of the 2 drugs, feedback from healthcare providers confirmed that tenecteplase was easier to calculate and administer in comparison with alteplase,” said Tiffany O. Sheehan, MD, RN FAHA, senior creator of the study and director of the Stroke Center Development Center at Barrow Neurological Institute at St. Hospital Joseph’s Hospital and Medical Center in Phoenix. “Giving a single infusion of tenecteplase is less complicated and provides health care providers with additional time to stabilize patients because they should not have to observe the hourly infusion of alteplase. This makes transferring patients to hospital simpler.”

“Along with being cheaper, our results confirm that tenecteplase is secure and as effective as alteplase. We are going to proceed to gather data on the security and outcomes of our practice, but we anticipate that other mobile stroke units across the country will begin using tenecteplase in the event that they aren’t already,” Haller said.

“Mobile stroke units are a really exciting solution because they shorten treatment times, and we all know that point is of the essence in relation to stroke. Nevertheless, in most U.S. cities, one of these treatment will not be available resulting from cost. So anything that could be done to cut back the prices and other challenges of operating a mobile stroke unit can have the potential to make an impact. Tenecteplase is increasingly getting used resulting from its ease of use, lower cost, and comparable safety and effectiveness in comparison with tPA,” said Mitchell SV Elkind, MD, MS, FAHA, American Heart Association chief clinical science officer, past president of the American Heart Association , former chairman of the American Stroke Association Advisory Committee; chapter of the American Heart Association and professor of neurology and epidemiology at Columbia University in Latest York. Dr. Elkind was not involved on this study.

The study has limitations in that it’s a retrospective evaluation of electronic medical records from a single mobile stroke unit. The researchers examined the time before and after the initiation of tenecteplase use in a mobile stroke unit and were unable to regulate for other changes in practice that will have occurred during this time.