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Journal Title: | Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke |
Authors: | Campbell, Bruce C. V. Mitchell, Peter J. Churilov, Leonid Yassi, Nawaf Kleinig, Timothy J. Dowling, Richard J. Yan, Bernard Bush, Steven J. Dewey, Helen M. Thijs, Vincent Scroop, Rebecca Simpson, Marion Brooks, Mark Asadi, Hamed Wu, Teddy Y. Shah, Darshan G.. Wijeratne, Tissa Ang, Timothy Miteff, Ferdinand Levi, Christopher R. Rodrigues, Edrich Zhao, Henry Salvaris, Patrick Garcia-Esperon, Carlos Bailey, Peter Rice, Henry de Villiers, Laetitia Brown, Helen Redmond, Kendal Leggett, David Fink, John N. Collecutt, Wayne Wong, Andrew A. Muller, Claire Coulthard, Alan Mitchell, Ken Clouston, John Mahady, Kate Field, Deborah Ma, Henry Phan, Thanh G. Chong, Winston Chandra, Ronil V. Slater, Lee-Anne Krause, Martin Harrington, Timothy J. Faulder, Kenneth C. Steinfort, Brendan S. Bladin, Christopher F. Sharma, Gagan Desmond, Patricia M. Parsons, Mark W. Donnan, Geoffrey A. Davis, Stephen M. EXTEND-IA TNK Investigators |
Keywords: | Aged 80 and Over Brain Ischemia Cerebral Hemorrhage Combined Modality Therapy Endovascular Procedures Female Fibrinolytic Agents Humans Logistic Models Male Middle Aged Reperfusion Severity of Illness Index Single Blind Method Stroke Tenecteplase Thrombectomy Treatment Tissue Plasminogen Activator |
Issue Date: | 2018 |
Date Accessioned: | 2023-04-24T02:44:19Z |
Date Available: | 2023-04-24T02:44:19Z |
Accession Number: | 29694815 |
Url: | https://www.ncbi.nlm.nih.gov/pubmed/29694815 |
Description Affiliation: | From the Departments of Medicine and Neurology, Melbourne Brain Centre (B.C.V.C., N.Y., B.Y., T.Y.W., D.G.S., E.R., H.Z., P.S., G.S., M.W.P., S.M.D.), and the Department of Radiology (P.J.M., R.J.D., S.J.B., P.M.D.), Royal Melbourne Hospital, and the Florey Institute of Neuroscience and Mental Health (L.C., N.Y., V.T., H.A., H.M., C.F.B., G.A.D.), University of Melbourne, Parkville, VIC, the Departments of Neurology (T.J.K.) and Radiology (R.S.), Royal Adelaide Hospital, and the Department of Neurology, Lyell McEwin Hospital (D.F.), Adelaide, SA, the Department of Neurosciences, Eastern Health and Eastern Health Clinical School (H.M.D., C.F.B.), and the Departments of Neurology (H.M., T.G.P.) and Radiology (W. Chong, R.V.C., L.-A.S.), Monash Medical Centre, Monash University, Clayton, VIC, the Departments of Neurology (V.T., M.S.) and Radiology (M.B., H.A.), Austin Hospital, Austin Health, Heidelberg, VIC, School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC (H.A.), and the Departments of Medicine and Neurology, Melbourne Medical School, University of Melbourne and Western Health, Sunshine Hospital, St. Albans, VIC (T.W.), the Departments of Neurology (D.G.S., H.B.) and Radiology (K.R., D.L.), Princess Alexandra Hospital, and the Departments of Neurology (A.A.W., C.M.) and Radiology (A.C., K. Mitchell, J.C., K. Mahady), Royal Brisbane and Women's Hospital and the University of Queensland, Brisbane, the Departments of Neurology (P.B.) and Radiology (H.R., L.V.), Gold Coast University Hospital, Southport, QLD, and the Department of Neurology, Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW (T.A., F.M., C.R.L., C.G.-E., M.W.P.), the Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney (M.K.), and the Department of Radiology, Royal North Shore Hospital (T.J.H., K.C.F., B.S.S.), St. Leonards, and the Department of Radiology, Westmead Hospital, Sydney (T.J.H., K.C.F., B.S.S.) - all in Australia; and the Departments of Neurology (T.Y.W., J.N.F.) and Radiology (W. Collecutt), Christchurch Hospital, Christchurch, New Zealand. |
Format Startpage: | 1573-1582 |
Source Volume: | 378 |
Issue Number: | 17 |
Database: | Medline |
Notes: | Clinical Trial, Phase II Comparative Study Multicenter Study Randomized Controlled Trial |
Abstract: | BACKGROUND: Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy for ischemic stroke. Tenecteplase, which is more fibrin-specific and has longer activity than alteplase, is given as a bolus and may increase the incidence of vascular reperfusion. METHODS: We randomly assigned patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery and who were eligible to undergo thrombectomy to receive tenecteplase (at a dose of 0.25 mg per kilogram of body weight; maximum dose, 25 mg) or alteplase (at a dose of 0.9 mg per kilogram; maximum dose, 90 mg) within 4.5 hours after symptom onset. The primary outcome was reperfusion of greater than 50% of the involved ischemic territory or an absence of retrievable thrombus at the time of the initial angiographic assessment. Noninferiority of tenecteplase was tested, followed by superiority. Secondary outcomes included the modified Rankin scale score (on a scale from 0 [no neurologic deficit] to 6 [death]) at 90 days. Safety outcomes were death and symptomatic intracerebral hemorrhage. RESULTS: Of 202 patients enrolled, 101 were assigned to receive tenecteplase and 101 to receive alteplase. The primary outcome occurred in 22% of the patients treated with tenecteplase versus 10% of those treated with alteplase (incidence difference, 12 percentage points; 95% confidence interval [CI], 2 to 21; incidence ratio, 2.2; 95% CI, 1.1 to 4.4; P=0.002 for noninferiority; P=0.03 for superiority). Tenecteplase resulted in a better 90-day functional outcome than alteplase (median modified Rankin scale score, 2 vs. 3; common odds ratio, 1.7; 95% CI, 1.0 to 2.8; P=0.04). Symptomatic intracerebral hemorrhage occurred in 1% of the patients in each group. CONCLUSIONS: Tenecteplase before thrombectomy was associated with a higher incidence of reperfusion and better functional outcome than alteplase among patients with ischemic stroke treated within 4.5 hours after symptom onset. (Funded by the National Health and Medical Research Council of Australia and others; EXTEND-IA TNK ClinicalTrials.gov number, NCT02388061 .). |
URI: | https://repository.southwesthealthcare.com.au/swhealthcarejspui/handle/1/3842 |
Journal Title: | The New England Journal of Medicine |
Type: | Journal Article |
Appears in Collections: | SWH Data Contributions |
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