Abstract TP7: The Utilization Of Tenecteplase In Reducing Door-to Needle Time In Ischemic Stroke Patients

Introduction: In September 2021 our emergency department (ED) switched from alteplase to tenecteplase for thrombolysis in acute ischemic stroke (AIS) 1 . Recent evidence suggests that tenecteplase may be as safe and effective as alteplase, while easier to dose and administer. We sought to reduce our door-to-needle (DTN) time, as faster treatment of AIS patients with fibrinolytics has been associated with improved outcomes 2 , reductions of in-hospital mortality and symptomatic intracerebral hemorrhage (ICH) 3 . Methods: Direct arriving patients entered into the Get With The Guidelines® Stroke (GWTG-Stroke) Patient Management Tool TM who received thrombolytics and were discharged from January 2019 through July 2022 were included. We compared outcomes before and after the switch from alteplase to tenecteplase in September 2021. The main outcome of this study was DTN time adjusted for demographic and clinical characteristics, including age, race/ethnicity, time of last known well, and presenting NIHSS. Data are presented as odds ratios (ORs) with 95% confidence intervals (CI) and statistical significance set at an alpha of 0.05. Results: Between January 2019 and July 2022, 127 patients met the inclusion criteria for this study, of which 82 received alteplase and 45 received tenecteplase. Patients who received tenecteplase had a median DTN time of 42 minutes (95% CI: 37.5-50.4) versus 60 minutes (95% CI: 60.2-74.9) for those who received alteplase (p<0.0001). A greater percentage of patients received tenecteplase, compared to patients who received alteplase, within 60 minutes (77.8% vs 51.2%, adjusted OR 3.74 (95% CI, 1.56-8.93) (p<0.01) and within 45 minutes (53.3% vs 30.5%, adjusted OR 3.26 (95% CI, 1.39-6.06) (p < 0.01). Rates of ICH within 36 hours did not differ significantly for patients receiving tenecteplase versus alteplase (4.4% versus 3.7%; p = 0.83), however it should be noted that overall ICH rate amongst the included patient population was 3.9% (n = 5). Conclusions: In conclusion, switching from alteplase to tenecteplase for the treatment of acute ischemic stroke significantly reduced DTN time in our ED without increasing ICH.