Switching to a newer clot-busting drug improves patient outcomes

AUSTIN, Texas — A new-generation clot-busting drug called tenecteplase is outperforming conventional treatment of ischemic strokes in several key areas, including better health outcomes and lower costs, according to the New study Published today in the American Stroke Association’s Journal brain attack.

The study was led by a team of neurologists at Dell Medical College of the University of Texas at Austin It was performed over 15 months at 10 Ascension Seton Hospitals in Central Texas beginning in September 2019.

“The Dell Med Neurology Stroke program was one of the first programs in the United States to make this change,” he said. Stephen WarachMD, lead author of the study and director of the Stroke Program for Dell Med and Ascension Texas. “Based on the early results of this study, other experts across the country are convinced and have switched from alteplase to tenecteplase at their own stroke centers, including Ascension hospitals across the country.”

Approximately 800,000 people in the United States He has a stroke every year. The vast majority of these strokes (about 87%) are ischemic, which means that they occur when one of the blood vessels that supply blood to the brain is obstructed by a blood clot. This can lead to a similar loss of neurological function.

Both tenecteplase and alteplase are federally approved for use in dissolving clots in blocked heart arteries. But the newer drug tenecteplase is also used by doctors, off-label, to treat strokes, because clinical trials in stroke suggest that it may be at least as good as alteplase and easier to administer. Tenecteplase is administered as a single intravenous injection of five to 10 seconds duration. The researchers compared its performance with the standard stroke drug, alteplase, which is injected over 60 minutes.

“When it comes to treating patients who have had a stroke, every second counts,” said Warach, who is also a professor of neuroscience at Dell Med. “Shorter preparation and injection time with tenecteplase not only eliminates a lot of alteplase-related dosing errors, but is also more efficient. We were able to deliver clot-busting medication more quickly after patients arrived at the emergency department, and for patients who needed to be transported to a hospital Another to get more advanced care after receiving clot treatment, we were able to start transfer sooner. Those treated with tenecteplase.”

For patients who come to the emergency department after a stroke, the Warach study found that the “door-to-needle” time — the time between patients arriving and the moment they receive treatment — was on average six minutes faster with tenecteplase. For patients who also required thrombectomy, that is, surgical removal of the blood clot causing the stroke, tenecteplase may speed up the process of transporting the patient to a stroke center capable of thrombectomy for 25 minutes.

The researchers also noted improvements in clinical outcomes for patients who were given tenecteplase, including:

  • 5% increase in the number of patients who were able to walk independently at the time of hospital discharge home.
  • 4% reduction in the incidence of adverse events such as brain hemorrhage, discharges for hospice care or death.

The third major improvement: cost. The research team found that tenecteplase treatment costs hospitals about $2,500 less than alteplase per patient.

“If this price differential persists,” he said, “the amount of savings could equate to more than $150 million annually in the United States.” David Baidarfar, MD, co-author of the study and chair of the division of neurology at Dell Med. “This is a great example of value-based care – better care for less money.”

Dell Med Neurology Stroke now works with colleagues in the country that funds it Lone Star Strokes Research Consortium to spread the results of her study across the state, helping more stroke centers switch to tenecteplase. Warach is also working with fellow Lone Star Stroke to build a statewide database to confirm their findings and answer outstanding questions.

“For example, we have such a large Latino population in Texas. I would like to know if we are seeing the same advantages from tenecteplase in this community as we are for a larger population,” Warach said. The more questions we can answer.”

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