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Journal Title: | Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke: A Post-Hoc Analysis of the EXTEND-IA TNK Trials |
Authors: | Yogendrakumar, Vignan Churilov, Leonid Mitchell, Peter J. Kleinig, Timothy J. Yassi, Nawaf Thijs, Vincent Wu, Teddy Shah, Darshan Bailey, Peter Dewey, Helen M. Choi, Philip M. Ma, Alice Wijeratne, Tissa Garcia-Esperon, Carlos Cloud, Geoffrey Chandra, Ronil V. Cordato, Dennis J. Yan, Bernard Sharma, Gagan Desmond, Patricia M. Parsons, Mark W. Donnan, Geoffrey A. Davis, Stephen M. Campbell, Bruce C. V. |
Keywords: | Tenecteplase Alteplase Tandem Lesion Stroke EXTEND-IA TNK Trials Stroke |
Issue Date: | May-2023 |
Date Accessioned: | 2023-04-24T02:44:24Z |
Date Available: | 2023-04-24T02:44:24Z |
Accession Number: | 36878701 |
Url: | https://www.ncbi.nlm.nih.gov/pubmed/36878701 |
Description Affiliation: | Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia vyogendrakum@student.unimelb.edu.au. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia. Melbourne Medical School, University of Melbourne, Heidelberg, Australia. Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia. Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia. Department of Neurology, Christchurch Hospital, Christchurch, New Zealand. Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. Department of Neurology, Gold Coast University Hospital, Queensland, Australia. Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Victoria, Australia. Royal North Shore Hospital, New South Wales, Australia. Melbourne Medical School, Department of Medicine and Neurology, The University of Melbourne and Western Health, Sunshine Hospital, St Albans Victoria, Australia. Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia. Department of Neurology, Alfred Hospital, Melbourne, Australia. Department of Neuroscience, Central Clinical School, Monash University, Melbourne. NeuroInterventional Radiology Unit, Monash Health, Monash University, Australia. Department of Neurology, Liverpool Hospital, University of New South Wales, Sydney, Australia. |
Database: | Publisher |
DOI: | 10.1212/WNL.0000000000207138 |
Date: | Mar 6 NLM 2023 |
Abstract: | BACKGROUND AND OBJECTIVE: The safety and efficacy of tenecteplase in patients with tandem lesion stroke is unknown. We performed a comparative analysis of tenecteplase versus alteplase in patients with tandem lesions. METHODS: We first compared the treatment effect of tenecteplase and alteplase in patients with tandem lesions using individual patient data from the EXTEND-IA TNK trials. We evaluated intracranial reperfusion at initial angiographic assessment and 90-day mRS with ordinal logistic and Firth regression models. Because two key outcomes, mortality and symptomatic intracranial hemorrhage, were few in number among those who received alteplase in the EXTEND-IA TNK trials, we generated pooled estimates for these outcomes by supplementing trial data with estimates of incidence obtained through a meta-analysis of studies identified in a systematic review. We then calculated unadjusted risk differences to compare the pooled estimates for those receiving alteplase with the incidence observed in the trial among those receiving tenecteplase. RESULTS: Seventy-one of 483 patients (15%) in the EXTEND-IA TNK trials possessed a tandem lesion. In tandem lesion patients, intracranial reperfusion was observed in 11/56 (20%) of tenecteplase treated patients vs. 1/15 (7%) alteplase treated patients (aOR: 2.19; 95% CI:0.28-17.29). No significant difference in 90-day mRS was observed (adjusted common OR: 1.48; 95% CI: 0.44-5.00). A pooled study-level proportion of alteplase associated mortality and symptomatic intracranial hemorrhage was 0.14 (95% CI: 0.08-0.21) and 0.09 (95% CI: 0.04-0.16), respectively. Compared to a mortality rate of 0.09 (95% CI: 0.03-0.20) and a symptomatic intracranial hemorrhage rate of 0.07 (95% CI: 0.02-0.17) in tenecteplase treated patients, no significant difference was observed. CONCLUSIONS: Functional outcomes, mortality, and symptomatic intracranial hemorrhage did not significantly differ between tenecteplase and alteplase treated tandem lesion patients. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that tenecteplase is associated with similar rates of intracranial reperfusion, functional outcome, mortality, and symptomatic intracranial hemorrhage compared with alteplase, in patients with acute stroke due to tandem lesions. However, the confidence intervals do not rule out clinically important differences. |
URI: | https://repository.southwesthealthcare.com.au/swhealthcarejspui/handle/1/3860 |
Journal Title: | Neurology |
Type: | Journal Article |
Appears in Collections: | SWH Data Contributions |
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