Tenecteplase for Acute Ischemic Stroke Treatment

2021 ◽  
Vol 41 (01) ◽  
pp. 028-038
Author(s):  
Alison E. Baird ◽  
Richard Jackson ◽  
Weijun Jin
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Recombinant Tissue Plasminogen Activator ◽  
The United States ◽  
Similar Efficacy ◽  
Plasminogen Activator Inhibitor 1 ◽  
Stroke Treatment ◽  
United States Food

AbstractThe introduction of thrombolytic therapy in the 1990s has transformed acute ischemic stroke treatment. Thus far, intravenous recombinant tissue plasminogen activator (rt-PA) also known as alteplase is the only thrombolytic proven to be efficacious and approved by the United States Food and Drug Administration. But the thrombolytic agent tenecteplase (TNK) is emerging as a potential replacement for rt-PA. TNK has greater fibrin specificity, slower clearance, and higher resistance to plasminogen activator inhibitor-1 than rt-PA. Hence, TNK has the potential to provide superior lysis with fewer hemorrhagic complications. Also, easier bolus-only administration makes TNK a very practical rt-PA alternative. In several clinical trials, TNK has shown similar efficacy and safety to rt-PA, and the potential to be at least noninferior to rt-PA in some settings. TNK may be superior to rt-PA for reperfusing large vessel occlusions in patients with salvageable penumbra, although this has not yet translated to improved clinical outcomes. Further phase 3 studies are in progress comparing rt-PA with TNK for acute ischemic stroke during the first 4.5 hours. Studies are also in progress to evaluate the use of TNK for extended applications, such as wake-up stroke.

scholarly journals Investigation of Recombinant Tissue Plasminogen Activator Complications in Treatment of patients with ischemic stroke visiting Vali-e-Asr hospital in Birjand, 2016-2017

2019 ◽  
Author(s):  
Hamid Reza Riasi ◽  
Elham Zarei ◽  
Forod Salehi ◽  
Fatemeh Sayehmiri
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Treatment Options ◽  
Recombinant Tissue Plasminogen Activator ◽  
Current Treatment ◽  
Fisher Exact Test ◽  
Stroke Treatment ◽  
Tissue Plasminogen

Abstract Background: Current treatment options for the sake of treating acute ischemic stroke include recombinant tissue plasminogen activator or dual anti platelet therapies. This study aims to evaluate the complications of recombinant tissue plasminogen activator in treatment of patients with ischemic stroke who were admitted in Vali-e-Asr hospital in Birjand, 2016-2017. Method: This descriptive analytic study was performed on patients with acute ischemic stroke who were admitted in neurology ward of Vali-e-Asr hospital in Birjand from 2016 to 2017. A total of 127 patients participated in this study. The data about complications of treatment were collected by questionnaires and entered into SPSS 21. Then, data were analyzed by Chi-square or Fisher exact test at a significant level of p≤ 0.5. Results: A total of 127 subjects received treatment for ischemic stroke. Thirty-one (24.4%) patients have been treated with recombinant tissue plasminogen activator and ninety-six (75.6%) have been treated conventionally with dual antiplatelet. These two groups were matched in terms of age and sex. The history of hypertension in the recombinant tissue plasminogen activator group and the conventional treatments were 32.3% and 67.7%, respectively (p=0.03). 99% of patients in the antiplatelet treatment group (N=96) and 96.8% of patients in the recombinant tissue plasminogen activator group (N=31) have been discharged and one death was occurred in each group (p=0.4). Regarding the incidence of recombinant tissue plasminogen activator complications, IVH was reported in two patients (6.5%, p = 0.06) Conclusion: The incidence of mortality was the same in two groups. Also, complications were only reported in two patients in the recombinant tissue plasminogen activator group (both intraventricular hemorrhage) and the difference was not statistically significant. Researchers recommend that more clinical trials must be conducted. If it is approved, the findings of the current studies will be widely taken into consideration for acute stroke treatment.

Association of admission leukocyte count with clinical outcomes in acute ischemic stroke patients undergoing intravenous thrombolysis with recombinant tissue plasminogen activator

2020 ◽  
Vol 17 ◽  
Author(s):  
Jie Chen ◽  
Fu-Liang Zhang ◽  
Shan Lv ◽  
Hang Jin ◽  
Yun Luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Leukocyte Count ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Functional Independence ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Objective:: Increased leukocyte count are positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. Methods:: This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 and December 2018. We assessed outcomes including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0–2 or 0–1). Results:: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio (OR): 1.076, 95% confidence interval (CI): 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95% CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-month functional outcomes or 3-month mortality. Conclusion:: Lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

Abstract TP286: A Literature Review of Cost-effectiveness of Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Guijing Wang ◽  
Heesoo Joo ◽  
Mary G George
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cost Effective ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
The Cost ◽  
Effectiveness Studies

Introduction: Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. Objectives: We conducted a literature review of the cost-effectiveness studies about IV rtPA. Methods: A literature search was conducted using PubMed, MEDLINE, and EconLit, with the key words stroke, cost, economic benefit, saving, cost-effectiveness, tissue plasminogen activator, and rtPA. The review is limited to original research articles published during 1995–2014 in English-language peer-reviewed journals. Results: We found 15 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 1 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective. Conclusions: The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.

Recombinant Tissue Plasminogen Activator Treatment in Two Infants With Fulminant Meningococcemia

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 144-148
Author(s):  
Werner Zenz ◽  
Wolfgang Muntean ◽  
Siegfried Gallistl ◽  
Gerfried Zobel ◽  
Hans M. Grubbauer
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Prognostic Significance ◽  
Case Fatality ◽  
Plasminogen Activator Inhibitor ◽  
Recombinant Tissue Plasminogen Activator ◽  
Acute Onset ◽  
Plasminogen Activator Inhibitor 1 ◽  
Tissue Plasminogen ◽  
Pai 1

Fulminant meningococcemia defines a life-threatening disease with acute onset, severe septic shock, and progressive hemorrhagic necrosis of the skin. Despite advances in intensive care, the case fatality rate of this disease is still between 30% and 50%.1-5 Disseminated intravascular coagulation (DIC) with deposition of fibrin and histologically demonstrable widespread microvascular thromboses contributes significantly to the pathogenesis.6-9 Impairment of fibrinolysis caused by elevation of plasminogen activator inhibitor 1 (PAI-1), the physiologic inhibitor of tissue plasminogen activator, is part of these clotting abnormalities and has prognostic significance; the extent of elevation of PAI-1 is correlated to the development of shock, renal impairment, and mortality.10,11

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