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Volume 32, Issue 151 (March & April 2024)
J Adv Med Biomed Res 2024, 32(151): 119-126 |
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Rafie S, Behzad E, Khazaali F, Molazadeh P, Baharvand A, Ansari Dezfouli M. The Primary Experience with Tenecteplase Thrombolysis for Acute Ischemic Stroke: A Report from Iran. J Adv Med Biomed Res 2024; 32 (151) :119-126
URL: http://journal.zums.ac.ir/article-1-7319-en.html
URL: http://journal.zums.ac.ir/article-1-7319-en.html
Shahram Rafie1 
, Ebrahim Behzad1 , Fatemeh Khazaali1 , Parnia Molazadeh1 , Amin Baharvand1 , Mitra Ansari Dezfouli * 2
, Ebrahim Behzad1 , Fatemeh Khazaali1 , Parnia Molazadeh1 , Amin Baharvand1 , Mitra Ansari Dezfouli * 2
1- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences. Ahvaz-Iran
2- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences. Ahvaz-Iran ,mitraansari84@gmail.com
2- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences. Ahvaz-Iran ,
Abstract: (172 Views)
Background & Objective: Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) has been considered as primary therapy in ischemic stroke patients. Alteplase is prescripted as the thrombolytic therapy for more than two decades. Tenecteplase is a new type of tPA that is reported to have beneficial effects in recent years. The present research focused on the effectiveness and the side effects of tenecteplase in the ischemic stroke.
Materials & Methods: Here we administrated 0.25 mg/kg tenecteplase in 36 individuals with acute ischemic stroke in the first 4.5 hours of stroke occurrence. The NIHSS in baseline, 24 hours, 7 days after and the modified Rankin scale (mRS) at 90 days were assessed. The primary efficacy outcome was reduction of at least 4 points in the NIHSS during 7 days and the secondary efficacy outcome was defined as mRS 0 and 1 at 90 days. The safety outcome was evaluated based on the symptomatic intracranial hemorrhage (ICH) and death occurance during 90 days.
Results: The mean NIHSS at baseline was 12.7±4.6, and the mean NIHSS corresponding to 24 hours after admission was 9.6±4.8. The mean 7-day NIHSS was 7.6±4.4. The primary and secondary efficacy outcomes were met in 18 (50%) and 22 (61.1 %) of the patients respectively. Symptomatic ICH was observed in one patient with lung cancer who died of respiratory failure.
Conclusion: This study confirmed the efficacy and safety of tenecteplase in thrombolysis for acute ischemic stroke treatment. Tenecteplase appears to be an appropriate therapy as thrombolytic agent against ischemic stroke.
Materials & Methods: Here we administrated 0.25 mg/kg tenecteplase in 36 individuals with acute ischemic stroke in the first 4.5 hours of stroke occurrence. The NIHSS in baseline, 24 hours, 7 days after and the modified Rankin scale (mRS) at 90 days were assessed. The primary efficacy outcome was reduction of at least 4 points in the NIHSS during 7 days and the secondary efficacy outcome was defined as mRS 0 and 1 at 90 days. The safety outcome was evaluated based on the symptomatic intracranial hemorrhage (ICH) and death occurance during 90 days.
Results: The mean NIHSS at baseline was 12.7±4.6, and the mean NIHSS corresponding to 24 hours after admission was 9.6±4.8. The mean 7-day NIHSS was 7.6±4.4. The primary and secondary efficacy outcomes were met in 18 (50%) and 22 (61.1 %) of the patients respectively. Symptomatic ICH was observed in one patient with lung cancer who died of respiratory failure.
Conclusion: This study confirmed the efficacy and safety of tenecteplase in thrombolysis for acute ischemic stroke treatment. Tenecteplase appears to be an appropriate therapy as thrombolytic agent against ischemic stroke.
Type of Study: Original Article |
Subject:
Clinical medicine
Received: 2023/08/15 | Accepted: 2024/01/3 | Published: 2024/03/2
Received: 2023/08/15 | Accepted: 2024/01/3 | Published: 2024/03/2
References
1. Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine. 2020;48(9):561-6. [DOI:10.1016/j.mpmed.2020.06.002] [PMID] [PMCID]
2. Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bullet World Health Organ. 2016;94(9):634. [DOI:10.2471/BLT.16.181636] [PMID] [PMCID]
3. O'donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-23. [DOI:10.1016/S0140-6736(10)60834-3] [PMID]
4. Mazaheri S, Darvish M, Pooroalajal J, Fariadras M. A comparative study on the effect of citicoline on acute ischemic and hemorrhagic stroke. Avicenna Clin Med. 2018;25(1):20-7. [DOI:10.21859/ajcm.25.1.20]
5. Campbell BC, De Silva DA, Macleod MR, et al. Ischaemic stroke. Nature Rev Dis Prim. 2019;5(1):70. [DOI:10.1038/s41572-019-0118-8] [PMID]
6. Murugan D, Selvaraj SK, Anandan AD, et al. Analysis of stroke-risk factors among stroke survivors. Int J Nutr Pharmacol Neurol Dis. 2022;12(3):120-5.
7. Urrutia VC, Faigle R, Zeiler SR, et al. Safety of intravenous alteplase within 4.5 hours for patients awakening with stroke symptoms. PLoS One. 2018;13(5):e0197714. [DOI:10.1371/journal.pone.0197714] [PMID] [PMCID]
8. Mahmood A, Muir KW. Tenecteplase or alteplase: what is the thrombolytic agent of the future? Curr Treat Option Neurol. 2022;24(10):503-13. [DOI:10.1007/s11940-022-00733-4] [PMID] [PMCID]
9. Chester KW, Corrigan M, Schoeffler JM, et al. Making a case for the right '-ase'in acute ischemic stroke: alteplase, tenecteplase, and reteplase. Expert Opin Drug Safety. 2019;18(2):87-96. [DOI:10.1080/14740338.2019.1573985] [PMID]
10. Warach SJ, Dula AN, Milling Jr TJ. Tenecteplase thrombolysis for acute ischemic stroke. Stroke. 2020;51(11):3440-51. [DOI:10.1161/STROKEAHA.120.029749] [PMID] [PMCID]
11. Baird AE, Jackson R, Jin W, et al. Tenecteplase for acute ischemic stroke treatment. Seminars in Neurology; 2021: Thieme Medical Publishers, Inc. [DOI:10.1055/s-0040-1722722] [PMID]
12. Fallahzadeh A, Esfahani Z, Sheikhy A, et al. National and subnational burden of stroke in Iran from 1990 to 2019. Ann Clin Transl Neurol. 2022;9(5):669-83. [DOI:10.1002/acn3.51547] [PMID] [PMCID]
13. Tanswell P, Modi N, Combs D, Danays T. Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction. Clin Pharmacokin. 2002;41:1229-45. [DOI:10.2165/00003088-200241150-00001] [PMID]
14. Campbell BC, Mitchell PJ, Churilov L, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. New Eng J Med. 2018;378(17):1573-82. [DOI:10.1056/NEJMoa1716405] [PMID]
15. Semba CP, Sugimoto K, Razavi MK. Alteplase and tenecteplase: applications in the peripheral circulation. Techniq Vasc Intervention Radiol. 2001;4(2):99-106.
https://doi.org/10.1053/tvir.2001.24834 [DOI:10.1016/S1089-2516(01)90003-4]
16. Guillermin A, Yan DJ, Perrier A, Marti C. Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: a systematic review and meta-analysis of randomized trials. Arch Med Sci. 2016;12(6):1181-7. [DOI:10.5114/aoms.2016.58929] [PMID] [PMCID]
17. Menon BK, Buck BH, Singh N, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet. 2022;400(10347):161-9. [DOI:10.1016/S0140-6736(22)01054-6] [PMID]
18. Kheiri B, Osman M, Abdalla A, et al. Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2018;46:440-50. [DOI:10.1007/s11239-018-1721-3] [PMID]
19. Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: present status and future perspectives. Int J Molec Sci. 2020;21(20):7609. [DOI:10.3390/ijms21207609] [PMID] [PMCID]
20. Campbell BC, Nguyen TN. Advances in stroke: treatments-interventional. Stroke. 2022;53(1):264-7. [DOI:10.1161/STROKEAHA.121.037039] [PMID]
21. Rabinstein AA. Update on treatment of acute ischemic stroke. Continuum: Lifelong Learning in Neurology. 2020;26(2):268-86. [DOI:10.1212/CON.0000000000000840] [PMID]
22. Casetta I, Pracucci G, Saletti A, et al. Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian registry of endovascular treatment in acute stroke. Int J Stroke. 2019;14(9):898-907. [DOI:10.1177/1747493019851279] [PMID]
23. Labarrere CA, Dabiri AE, Kassab GS. Thrombogenic and inflammatory reactions to biomaterials in medical devices. Front Bioengin Biotechnol. 2020;8:123. [DOI:10.3389/fbioe.2020.00123] [PMID] [PMCID]
24. Pilgram-Pastor SM, Piechowiak EI, Dobrocky T, et al. Stroke thrombectomy complication management. J Neurointervention Surg. 2021;13(10):912-7. [DOI:10.1136/neurintsurg-2021-017349] [PMID] [PMCID]
25. dela Peña I, Borlongan C, Shen G, Davis W. Strategies to extend thrombolytic time window for ischemic stroke treatment: an unmet clinical need. J Stroke. 2017;19(1):50. [DOI:10.5853/jos.2016.01515] [PMID] [PMCID]
26. LeCouffe NE, Kappelhof M, Treurniet KM, et al. A randomized trial of intravenous alteplase before endovascular treatment for stroke. New Eng J Med. 2021;385(20):1833-44. [DOI:10.1056/NEJMoa2107727] [PMID]
27. NINDS T. The national institute of neurological disorders and stroke rt-pa stroke study group. tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7. [DOI:10.1056/NEJM199512143332401] [PMID]
28. Gibson CM, Marble SJ. Issues in the assessment of the safety and efficacy of tenecteplase (TNK‐tPA). Clinical cardiology. 2001;24(9):577-84. [DOI:10.1002/clc.4960240903] [PMID] [PMCID]
29. Behrouz R. Intravenous tenecteplase in acute ischemic stroke: an updated review. J Neurol. 2014;261:1069-72. [DOI:10.1007/s00415-013-7102-0] [PMID]
30. Logallo N, Kvistad CE, Nacu A, Thomassen L. Novel thrombolytics for acute ischemic stroke: challenges and opportunities. CNS Drugs. 2016;30:101-8. [DOI:10.1007/s40263-015-0307-2] [PMID]
31. Marshall RS. Progress in intravenous thrombolytic therapy for acute stroke. JAMA Neurol. 2015;72(8):928-34. [DOI:10.1001/jamaneurol.2015.0835] [PMID]
32. Li G, Wang C, Wang S, Xiong Y, Zhao X. Tenecteplase in ischemic stroke: challenge and opportunity. Neuropsychiatr Dis Treat. 2022;18:1013. [DOI:10.2147/NDT.S360967] [PMID] [PMCID]
33. Cui Y, Wang XH, Zhao Y, et al. Change of serum biomarkers to post-thrombolytic symptomatic intracranial hemorrhage in stroke. Front Neurol. 2022;13:889746.
https://doi.org/10.3389/fneur.2022.751912 [DOI:10.3389/fneur.2022.889746]
34. Yuh WT, Alexander MD, Beauchamp NJ. Intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(12):1176. [DOI:10.1056/NEJMc1501204]
35. Haley Jr EC, Lyden PD, Johnston KC, Hemmen TM, Investigators TiS. A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke. Stroke. 2005;36(3):607-12. [DOI:10.1161/01.STR.0000154872.73240.e9] [PMID]
36. Kvistad CE, Næss H, Helleberg BH, et al. Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022;21(6):511-9. [DOI:10.1016/S1474-4422(22)00124-7] [PMID]
37. Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol. 2017;16(10):781-8. [DOI:10.1016/S1474-4422(17)30253-3] [PMID]
38. Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. New Eng J Med. 2012;366(12):1099-107. [DOI:10.1056/NEJMoa1109842] [PMID]
39. Berge E, Whiteley W, Audebert H, et al. European stroke organization (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Europ Stroke J. 2021;6(1):I-LXII. [DOI:10.1177/2396987321989865] [PMID] [PMCID]
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