University of Otago
Department of Medicine
Professor Anna Ranta is a Wellington New Zealand based academic stroke neurologist whose research focuses on translational stroke research to optimise stroke care quality and access with a strong emphasis on addressing health inequities. Her main area of clinical and research expertise is in hyper-acute stroke therapies, but she also has experience in stroke epidemiology, health economics, workforce, and rehabilitation research. Her work to date has resulted in 200+ peer reviewed publications. She has led several large research programmes and also collaborates widely with others across Australasia and globally. She is the Head of Department of Medicine at University of Otago, Wellington, leads the New Zealand National Stroke Registry, and co-leads the New Zealand National Stroke Clot Retrieval Service Improvement Programme via a Ministry of Health position. She is the immediate past Chair of the New Zealand National Stroke Network, the current President of the Neurological Association of New Zealand, the Treasurer of Stroke Society of Australasia, Board Member of the World Stroke Organization, and serves on the editorial boards of Stroke and Neurology.

Moderator of 1 Session

Presenter of 2 Presentations

Environmental and Climate Change & Stroke

Session Type
Other
Date
Fri, 28.10.2022
Session Time
15:15 - 16:45
Room
Summit 1
Lecture Time
15:17 - 15:34

TENECTEPLASE VERSUS ALTEPLASE IN THE REAL WORLD: UPDATED NEW ZEALAND DATA

Session Type
Acute Stroke Treatment
Date
Wed, 26.10.2022
Session Time
08:00 - 09:30
Room
Nicoll 2-3
Lecture Time
08:20 - 08:30

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.

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