Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/28605
Title: Safety and Efficacy of Tenecteplase in Older Patients With Large Vessel Occlusion: A Pooled Analysis of the EXTEND-IA TNK Trials.
Austin Authors: Yogendrakumar, Vignan;Churilov, Leonid ;Mitchell, Peter J;Kleinig, Timothy J;Yassi, Nawaf;Thijs, Vincent N ;Wu, Teddy Y;Shah, Darshan G;Ng, Felix C ;Dewey, Helen M;Wijeratne, Tissa;Yan, Bernard;Desmond, Patricia M;Parsons, Mark W;Donnan, Geoffrey Alan;Davis, Stephen M;Campbell, Bruce C V
Affiliation: The Florey Institute of Neuroscience and Mental Health..
Medicine (University of Melbourne)..
Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Victoria, 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, Liverpool Hospital, University of New South Wales, Sydney, Australia..
Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia..
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia..
Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia..
Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia..
Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia..
Department of Neurology, Christchurch Hospital, Christchurch, New Zealand..
Issue Date: 22-Mar-2022
Date: 2022-01-11
Publication information: Neurology 2022; 98(12): e1292-e1301
Abstract: Detailed study of tenecteplase (TNK) in patients greater than 80 years of age is limited. The objective of our study was to assess the safety and efficacy of TNK at 0.25 and 0.40 mg/kg doses in patients greater than 80 years with large vessel occlusion. A pooled analysis of the EXTEND-IA TNK randomized controlled trials (n=502). Patients were adults presenting with ischemic stroke due to occlusion of the intracranial internal carotid, middle cerebral, or basilar artery presenting within 4.5 hours of symptom onset. We compared the treatment effect of TNK 0.25mg/kg, TNK 0.40mg/kg, and alteplase 0.90mg/kg, stratifying for patient age (>80 years). Outcomes evaluated include 90-day modified Rankin scale (mRS), all-cause mortality, and symptomatic ICH. Treatment effect was adjusted for baseline NIHSS, age, and time from symptom onset to puncture via mixed effects proportional odds and logistic regression models. In patients >80 years (n=137), TNK 0.25 mg/kg was associated with improved 90-day mRS (median 3 vs. 4, adjusted common OR=2.70, 95% CI: 1.23-5.94) and reduced mortality (aOR=0.34, 95% CI: 0.13-0.91) versus 0.40 mg/kg. TNK 0.25 mg/kg was associated with improved 90-day mRS (median 3 vs. 4, acOR=2.28, 95% CI: 1.03-5.05) versus alteplase. No difference in 90-day mRS or mortality was detected between alteplase and TNK 0.40 mg/kg. Symptomatic ICH was observed in 4 patients treated with TNK 0.40 mg/kg, one patient treated with alteplase and zero patients treated with TNK 0.25 mg/kg. In patients ≤ 80 years, no differences in 90-day mRS, mortality, or symptomatic ICH was observed between TNK 0.25 mg/kg, alteplase, and TNK 0.40 mg/kg. TNK 0.25 mg/kg was associated with improved 90-day mRS and lower mortality in patients greater than 80 years of age. No differences between the doses were observed in younger patients. This study provides Class II evidence that tenecteplase 0.25 mg/kg given before endovascular therapy in patients >80 years old with large vessel occlusion stroke is associated with better functional outcomes at 90 days and reduced mortality when compared to tenecteplase 0.40 mg/kg or alteplase 0.90 mg/kg. ClinicalTrials.gov Identifiers: NCT02388061, NCT03340493 https://www.clinicaltrials.gov/ct2/show/NCT02388061 https://www.clinicaltrials.gov/ct2/show/NCT03340493.
URI: https://ahro.austin.org.au/austinjspui/handle/1/28605
DOI: 10.1212/WNL.0000000000013302
ORCID: 0000-0001-8814-6853
0000-0002-6614-8417
0000-0001-6973-8677
0000-0001-9484-2070
0000-0002-1701-7111
0000-0003-3632-9433
0000-0002-9807-6606
Journal: Neurology
PubMed URL: 35017305
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35017305/
Type: Journal Article
Appears in Collections:Journal articles

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