Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/18030
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 A;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
Affiliation: Departments of Medicine and Neurology, Melbourne Brain Centre and the Department of Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia
The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
Department of Radiology, Royal Adelaide Hospital, Adelaide, SA, Australia
Department of Neurology, Lyell McEwin Hospital, Adelaide, SA, Australia
Department of Neurosciences, Eastern Health and Eastern Health Clinical School
Departments of Neurology and Radiology, Monash Medical Centre, Monash University, Clayton, VIC, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC, Australia
Departments of Medicine and Neurology, Melbourne Medical School, University of Melbourne and Western Health, Sunshine Hospital, St. Albans, VIC
Departments of Neurology and Radiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Departments of Neurology and Radiology, Royal Brisbane and Women's Hospital and the University of Queensland, Brisbane, QLD, Australia
Departments of Neurology and Radiology, Gold Coast University Hospital, Southport, QLD, Australia
Department of Neurology, Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia
Department of Radiology, Royal North Shore Hospital, St. Leonards, NSW, Australia
Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
Departments of Neurology and Radiology, Christchurch Hospital, Christchurch, New Zealand
0000-0002-6614-8417
Issue Date: 26-Apr-2018
Citation: The New England journal of medicine 2018; 378(17): 1573-1582
Abstract: 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. 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. 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. 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: http://ahro.austin.org.au/austinjspui/handle/1/18030
DOI: 10.1056/NEJMoa1716405
ORCID: 0000-0003-3632-9433
PubMed URL: 29694815
Type: Clinical Trial, Phase II
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Appears in Collections:Journal articles

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