UNDERSTANDING CURRENT PRACTICE PATTERNS REGARDING INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH ACUTE STROKE ELIGIBLE FOR ENDOVASCULAR TREATMENT (ID 1802)
Abstract
Background And Aims
Recent trials have challenged the role of intravenous thrombolysis using alteplase in the setting of stroke due to large vessel occlusion (LVO). The role of intravenous tenecteplase in this setting has not been studied in a large randomized controlled trial (RCT), but early results suggests it produces superior recanalization vs. alteplase. Physician practice and preferences in light of these evidence are unknown.
Methods
An international, cross-sectional web-based survey among physicians treating stroke, conducted after the MR CLEAN NO IV RCT results were presented (03/2021). Demographic information was collected from survey respondents. 6 questions with multiple choices were administered.
Results
225 physicians (66% male) from 44 countries responded. 92.4% of respondents would offer iv thrombolysis to patients with LVO stroke eligible for both thrombolysis and EVT. 64.7% respondents said that their practice did not change in light of recent trials. If offered an option to delay thrombolysis, 20% respondents would wait for 30 mins after groin puncture before offering iv thrombolysis, 7.5% would wait for 60 minutes and 5.2% would not offer thrombolysis at all. 60.4% would choose to use tenecteplase instead of alteplase. The cost of thrombolysis would influence decision-making for 40% of respondents (Figure)
Conclusions
This worldwide survey suggests that there is variability in how physicians interpret the recent direct to EVT trials. The appeal of a novel thrombolytic(tenecteplase) agent implies that the question of iv thrombolysis in patients with LVO eligible for EVT remains unanswered.
