Acute ischemic stroke thrombolysis with tenecteplase: An institutional experience from South India

Owais, Mohammed; Panwar, Ajay; Valupadas, Chandrasekhar; Veeramalla, Madhavarao

doi:10.4103/aam.aam_50_17

Cited by 12 publications

(7 citation statements)

References 11 publications

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“…Post therapy improvements in primary outcomes and secondary outcomes were comparable to other studies. 11 Our study showed positive correlation of age with post treatment scores which helped predict outcome and this agrees to study results of young stroke by Owais et al 12 It suggests that the results holds true even for the adult population that there is poorer response to tenecteplase with advancing age. Another interesting observation was the significant improvement in mean mRS scores in the moderate strokes when compared to the higher degree strokes which as a matter of fact showed mild worsening which points to the fact that there is a very significant delayed treatment improvement in moderate stroke group with tenecteplase.…”

Section: Discussionsupporting

confidence: 90%

Thrombolysis with novel tenecteplase in acute ischemic stroke: A prospective observational study from a rural tertiary care center in South India

Subir¹,

N.C²,

Ghafoor³

et al. 2021

IJN

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Tenecteplase is an approved engineered recombinant tissue plasminogen activator for treatment of acute ischemic stroke with molecular and practical advantages. It could be quintessential in this era of endovascular care provided that more studies come out, especially from resource poor settings. To observe the clinico-epidemiological profile and to assess the outcome of acute ischemic stroke patients treated with tenecteplase. A prospective observational study of stroke patients treated with tenecteplase. On admission clinical characteristics, temporal, epidemiological, imaging parameters, outcome measures including baseline NIHSS, NIHSS at 1 hour, 24 hours, at discharge, and modified Rankin Scores (mRS) at 0, 1 and 3 months were recorded in a structured proforma. Out of the 19 patients thrombolysed with tenecteplase 68.4% were males. Mean age of the study population was 61.3 years. Hypertension (57.9%), diabetes mellitus (36.8%) and smoking(26.3%) were the most common risk factors.Time parameters like mean onset to door time, door to image and door to needle time were 126 minutes, 29minutes and 66 minutes respectively, which were confirming with the international standards. Mean NIHSS was 11.1 and serial improvement was noted in the post treatment mean NIHSS scores at 1 hours, 24 hours and 7days with values of 8.6,8.0 and 7.7 respectively ( F=5.619,p=0.018). The mean mRS score was 3.5 and the follow up mRS at 1 month (2.4) and 3 months (1.7) (F=19.32, p<0.001) revealed significant functional improvement. The spearman test showed a positive correlation of age with all the serial post treatment NIHSS and mRS scores even when it did not affect the baseline NIHSS and mRS scores suggesting a poor response to tenecteplase with increasing age. Major improvement in mRS scores described as either a score of 0 or 1 or else a three-point improvement from baseline was seen in 47% (9) of thrombolysed patients and a major improvement in NIHSS scores was seen in 26% (5) patients. Symptomatic intracranial hemorrhage (sICH) was seen in only 5% of the study population. Thrombolysis with tenecteplase is faster, safer and effective but the treatment response decreases with increasing age.

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Section: Discussionsupporting

confidence: 90%

Thrombolysis with novel tenecteplase in acute ischemic stroke: A prospective observational study from a rural tertiary care center in South India

Subir¹,

N.C²,

Ghafoor³

et al. 2021

IJN

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“…According to Owais et al 71% of the patients were men and their mean age was 60.7 years [20]. Also, Gioia et al stated that among 60 patients with ischemic stroke, 67% were men and their mean age was 73.5 years [21].…”

Section: Discussionmentioning

confidence: 98%

“…We found hypertension as the most common comorbidity (n=235, 64.7%). Other studies mentioned diabetes mellitus and hyperlipidemia in addition to hypertension as common risk factors in AFAIS patients [15,20,22].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Prescription of New Anticoagulant Drugs and Its Determinant Factors in Patients With Ischemic Stroke and Non-valvular Atrial Fibrillation

Moaddabi

Ghayeghran

Hatamian

et al. 2020

Caspian J Neurol Sci

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Background: Patients with ischemic stroke and underlying Atrial Fibrillation (AF) have a high risk of recurrent embolic events. New Oral Anticoagulant (NOAC) is highly effective and reduces the risk of recurrence in AF-associated Ischemic Stroke (AFAIS). Objectives: This study aimed to determine the prescription pattern of NOAC and its determinant factors in patients with non-valvular AFAIS. Materials & Methods: This research was a cross-sectional descriptive study and the participants were referred to an academic hospital in the north of Iran from 2017 to 2018. The study variables included demographic variables such as the use of new anticoagulants, age, sex, place of residence, income level, education, the history of stroke and myocardial Infarction (MI), medication, and stroke severity based on The National Institutes of Health Stroke Scale criteria. The patient’s functional status based on the modified Rankin Scale (mRS) was extracted from the patients’ medical records. The data analysis was conducted by SPSS V. 19, using the Chi-square test and t-test, as well as the logistic regression model. Results: In this study, 363 patients with ischemic stroke with the origin of non-valvular AF and the mean age of 67.87 years were studied. Of them, 191 (52.6%) patients were women, and 30.6% were prescribed rivaroxaban at the time of discharge. The results showed that women were more likely to use rivaroxaban than men (P=0.001, OR=0.422). The history of stroke (P=0.004, OR=2.17) and the stroke severity (P=0.05, OR=2.19) was associated with an increase in NOAC prescription. Conclusion: The results of this study showed that the administration of NOAC in this population was low and associated with gender and the severity and the history of stroke.

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“…The comparative studies comprised 9 RCTs 2-4,12,14-18 (that included 3699 patients), 1 prospective, observational cohort study 19 (that included 50 patients) and 6 retrospective, observational cohort studies 10,[20][21][22][23][24] (that included 2614 patients). The 10 noncomparative studies comprised 2 RCTs (1 that compared 2 doses of tenecteplase with each other 11 and 1 that compared tenecteplase with usual care excluding thrombolysis; 25 total 588 tenecteplase-treated patients), 5 prospective, interventional studies (reported in 4 articles; [26][27][28][29] total 266 tenecteplase-treated patients), 2 prospective, observational studies 30,31 (total 126 tenecteplase-treated patients), and 1 retrospective, observational study 32 (total 570 tenecteplase-treated patients). Most studies included participants treated via a timebased threshold for thrombolytic administration.…”

Section: Study Characteristicsmentioning

confidence: 99%

Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Rose

Cavalier

Kam

et al. 2023

Stroke

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BACKGROUND: Prior systematic reviews have compared the efficacy of intravenous tenecteplase and alteplase in acute ischemic stroke, assigning their relative complications as a secondary objective. The objective of the present study is to determine whether the risk of treatment complications differs between patients treated with either agent. METHODS: We performed a systematic review including interventional studies and prospective and retrospective, observational studies enrolling adult patients treated with intravenous tenecteplase for ischemic stroke (both comparative and noncomparative with alteplase). We searched MEDLINE, Embase, the Cochrane Library, Web of Science, and the www.ClinicalTrials.gov registry from inception through June 3, 2022. The primary outcome was symptomatic intracranial hemorrhage, and secondary outcomes included any intracranial hemorrhage, angioedema, gastrointestinal hemorrhage, other extracranial hemorrhage, and mortality. We performed random effects meta-analyses where appropriate. Evidence was synthesized as relative risks, comparing risks in patients exposed to tenecteplase versus alteplase and absolute risks in patients treated with tenecteplase. RESULTS: Of 2226 records identified, 25 full-text articles (reporting 26 studies of 7913 patients) were included. Sixteen studies included alteplase as a comparator, and 10 were noncomparative. The relative risk of symptomatic intracranial hemorrhage in patients treated with tenecteplase compared with alteplase in the 16 comparative studies was 0.89 ([95% CI, 0.65–1.23]; I 2 =0%). Among patients treated with low dose (<0.2 mg/kg; 4 studies), medium dose (0.2–0.39 mg/kg; 13 studies), and high dose (≥0.4 mg/kg; 3 studies) tenecteplase, the RRs of symptomatic intracranial hemorrhage were 0.78 ([95% CI, 0.22–2.82]; I 2 =0%), 0.77 ([95% CI, 0.53–1.14]; I 2 =0%), and 2.31 ([95% CI, 0.69–7.75]; I 2 =40%), respectively. The pooled risk of symptomatic intracranial hemorrhage in tenecteplase-treated patients, including comparative and noncomparative studies, was 0.99% ([95% CI, 0%–3.49%]; I 2 =0%, 7 studies), 1.69% ([95% CI, 1.14%–2.32%]; I 2 =1%, 23 studies), and 4.19% ([95% CI, 1.92%–7.11%]; I 2 =52%, 5 studies) within the low-, medium-, and high-dose groups. The risks of any intracranial hemorrhage, mortality, and other studied outcomes were comparable between the 2 agents. CONCLUSIONS: Across medium- and low-dose tiers, the risks of complications were generally comparable between those treated with tenecteplase versus alteplase for acute ischemic stroke.

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Acute ischemic stroke thrombolysis with tenecteplase: An institutional experience from South India

Cited by 12 publications

References 11 publications

Thrombolysis with novel tenecteplase in acute ischemic stroke: A prospective observational study from a rural tertiary care center in South India

Thrombolysis with novel tenecteplase in acute ischemic stroke: A prospective observational study from a rural tertiary care center in South India

The Prevalence of Prescription of New Anticoagulant Drugs and Its Determinant Factors in Patients With Ischemic Stroke and Non-valvular Atrial Fibrillation

Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

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