Differences In Door-To-Needle And Door-In-Door-Out Times For Tenecteplase Vs Alteplase In Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke
Abstract Body (Do not enter title and authors here): Introduction: Tenecteplase (TNK) has arisen as an alternative to alteplase (ALT) for emergent treatment of acute ischemic stroke. Shorter times to prepare and administer TNK raises the possibility that TNK use leads to faster treatment and transfer times. Hypothesis: We hypothesized that treatment with TNK is associated with shorter door-to-needle (DTN) and door-in-door-out (DIDO) times. Methods: Using the US Get With The Guidelines-Stroke registry, we performed a retrospective, observational cohort study of consecutive patients treated with either TNK or ALT between July 1, 2020 and June 30, 2022. The exposure was treatment with TNK vs ALT. The primary endpoints were DTN and DIDO. We fit generalized linear mixed models to determine the association between TNK (vs ALT) and endpoints after adjustment for key demographic, clinical, and hospital-level variables. A secondary analysis compared changes in DTN among hospitals that switched to TNK in 2021 with at least 10 cases per year pre and post switch. Results: From 2092 sites, 133,228 patients received intravenous thrombolysis. Among the 13,988 (10%) treated with TNK, median age was 70 yrs, median NIHSS 7, 47% female, 21% received endovascular thrombectomy (EVT), and 9% were transferred from the hospital emergency department after receiving lytic. Among 119,240 (90%) treated with ALT, median age was 69 yrs, median NIHSS 7, 48% female; 17% received EVT, and 12% were transferred after lytic. In the primary DTN analysis, time to treatment was shorter with TNK, with mean 47.0 vs 52.7 minutes and DTN ≤60 mins in 77.5% vs 70.7% (TABLE). In the primary DIDO analysis, time to departure was shorter with TNK, 108.3 vs 114.1 mins. In centers that changed from ALT to TNK during this period DTN times were significantly lower after switching. Conclusions: In this largest study of TNK vs ALT workflow time intervals in ischemic stroke using population-based data, TNK use was associated with more favorable DTN and DIDO times relative to ALT use.
Warach, Steven
( University of Texas at Austin
, Austin
, Texas
, United States
)
Sampaio, Gisele
( Federal University of São Paulo (UNIFESP) and Hospital Israelita Albert Einstein
, São Paulo
, Brazil
)
Mac Grory, Brian
( Duke University
, Durham
, North Carolina
, United States
)
Xian, Ying
( University of Texas Southwestern
, Dallas
, Texas
, United States
)
Saver, Jeffrey
( Geffen School of Medicine at UCLA
, Los Angeles
, California
, United States
)
Weber, Jeremy
( Duke University
, Durham
, North Carolina
, United States
)
Alhanti, Brooke
( Duke University
, Durham
, North Carolina
, United States
)
Messe, Steven
( University of Pennsylvania
, Philadelphia
, Pennsylvania
, United States
)
Schwamm, Lee
( Yale University School of Medicine
, New Haven
, Connecticut
, United States
)
Fonarow, Gregg
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Sheth, Kevin
( Yale University School of Medicine
, New Haven
, Connecticut
, United States
)
Smith, Eric
( University of Calgary
, Calgary
, Alberta
, Canada
)
Mullen, Michael
( Lewis Katz School of Medicine at Temple University
, Philadelphia
, Pennsylvania
, United States
)
Author Disclosures:
Steven Warach:DO have relevant financial relationships
;
Consultant:Genentech:Past (completed)
| Gisele Sampaio:DO NOT have relevant financial relationships
| Brian Mac Grory:No Answer
| Ying Xian:DO NOT have relevant financial relationships
| Jeffrey Saver:DO have relevant financial relationships
;
Consultant:Medtronic:Active (exists now)
; Consultant:Astrocyte Pharma:Active (exists now)
| Jeremy Weber:DO NOT have relevant financial relationships
| Brooke Alhanti:DO NOT have relevant financial relationships
| Steven Messe:DO NOT have relevant financial relationships
| Lee Schwamm:DO have relevant financial relationships
;
Consultant:genentech:Active (exists now)
; Consultant:penumbra:Past (completed)
; Consultant:medtronic:Active (exists now)
| Gregg Fonarow:DO have relevant financial relationships
;
Consultant:Abbott:Past (completed)
; Consultant:Johnson and Johnson:Past (completed)
; Consultant:Pfizer:Active (exists now)
; Consultant:Novartis:Active (exists now)
; Consultant:Medtronic:Active (exists now)
; Consultant:Merck:Active (exists now)
; Consultant:Eli Lilly:Past (completed)
; Consultant:Boehringer Ingelheim:Past (completed)
; Consultant:Cytokinetics:Active (exists now)
; Consultant:Bayer:Active (exists now)
; Consultant:Astra Zeneca:Past (completed)
; Consultant:Amgen:Past (completed)
| Kevin Sheth:No Answer
| Eric Smith:DO NOT have relevant financial relationships
| Michael Mullen:DO NOT have relevant financial relationships
