Moderator of 1 Session
Presenter of 2 Presentations
Environmental and Climate Change & Stroke
TENECTEPLASE VERSUS ALTEPLASE IN THE REAL WORLD: UPDATED NEW ZEALAND DATA
Abstract
Background and Aims
There is potential risk of temporal confounding when assessing Tenecteplase (TNK) real world data using the typical before and after design. After our change to TNK in 2020 we were forced to change back in 2021 due to a sudden cessation of drug supply providing a unique opportunity to control for temporal trends.
Methods
In New Zealand all thrombolysed patients are entered prospectively into a central database for safety monitoring. We assessed patient outcomes and treatment metrics over three time periods: before switch (January 2018- January 2020); during TNK use (February 2020-February 2021) and after reverting to Alteplase (February 2021 to February 2022) adjusting regression analyses for age, sex, NIHSS, pre-morbid mRS and thrombectomy.
Results
The Central Hyper-Acute Stroke Network serves 1.17 million people. Between January 2018 and February 2022, we treated 773 patients with alteplase and 284 with TNK. Overall, patients treated with TNK had greater odds of mRS of 0-2 (aOR=1.81; 95%CI=1.13-2.89); shorter median (IQR) door-to-needle (DTN) time (52 (38-73) vs 60 (45-84) minutes, p=0.0001) and needle to groin (NTG) times (118 (74.5-218.5) versus 159 (104-244); p=0.11). Symptomatic ICH rate was lower in TNK group but did not quite reach statistical significance (p=0.071). DTN and NTG times were shorter with TNK ((52 (38-73) and 118 (74.5-218.5)) compared with alteplase pre-TNK (61 (45-85) and 157.5 (92-219)) and Alteplase post-TNK (60 (45-82) and 163 (116-265)).
Conclusions
A forced reversion from Tenecteplase to Alteplase demonstrates that previously reported benefits from TNK in a real-world setting were not simply attributable to a concurrent temporal trend.