Routine Use of Tenecteplase for Thrombolysis in Acute Ischemic Stroke
Routine Use of Tenecteplase for Thrombolysis in Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.120.030859
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发表时间：
2021-03-01
期刊：
影响因子：
8.3
通讯作者：
Wu, Teddy Y.
中科院分区：
文献类型：
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作者：
Zhong, Cathy S.;Beharry, James;Wu, Teddy Y.
背景和目的：在缺血性卒中患者中，静脉注射替替普酶并不比阿替普酶差，具有一定的实用价值。新西兰的几个卒中中心改为常规的非标签静脉替替普酶，原因是大血管闭塞的早期再通得到改善，卒中网络内血栓切除的途径不一致，以及有大血管闭塞的患者和没有大血管闭塞的患者之间的治疗方案一致。方法：我们对2018年7月14日至2020年2月29日期间在1个综合性卒中中心和2个区域卒中中心使用替替普酶静脉溶栓的连续患者进行了回顾性分析。我们报告了基线的临床特征、症状性颅内出血和血管水肿的发生率。然后将这些结果与在另外两个综合性卒中中心接受静脉注射阿尔替普酶治疗的患者的结果进行比较。采用多因素混合效应Logistic回归模型分析替替普酶与症状性脑出血及独立预后(改良Rankin评分0~2分)之间的关系。结果：替替普酶治疗165例，阿替普酶治疗254例。两组患者的年龄(75岁比74岁)、性别(56%比60%男性)、美国国立卫生研究院中风量表评分(8分比10分)、中位数到针灸时间(47分钟比48分钟)或发病到针灸时间(129分钟比130分钟)相似。替替普利组发生症状性颅内出血3例(1.8%[95%CI，0.4~5.3])，阿替普利组7例(2.7%[95%CI，1.1~5.7])(P=0.75)。Tenecteplase组和Alteplase组血管水肿率分别为4例[2.4%；95%CI，0.7~6.2]和1例[0.4%；95%CI，0.01~2.2](P=0.08)，90天功能独立发生率分别为100例[61%]和140例[57%]，P=0.47。在混合效应Logistic回归模型中，溶栓选择与症状性颅内出血无显著关联(优势比替替普酶，0.62[95%CI，0.14~2.80]，P=0.53)或功能独立性(优势比替替普酶，1.20[95%CI，0.74~1.95]，P=0.46)。结论：常规应用替替普酶治疗卒中血栓是可行的，其安全性和预后与替替普酶相当。
Background and Purpose:In ischemic stroke, intravenous tenecteplase is noninferior to alteplase in selected patients and has some practical advantages. Several stroke centers in New Zealand changed to routine off-label intravenous tenecteplase due to improved early recanalization in large vessel occlusion, inconsistent access to thrombectomy within stroke networks, and for consistency in treatment protocols between patients with and without large vessel occlusion. We report the feasibility and safety outcomes in tenecteplase-treated patients.Methods:We performed a retrospective analysis of consecutive patients thrombolyzed with intravenous tenecteplase at 1 comprehensive and 2 regional stroke centers from July 14, 2018, to February 29, 2020. We report the baseline clinical characteristics, rates of symptomatic intracranial hemorrhage, and angioedema. These were then compared with patient outcomes with those treated with intravenous alteplase at 2 other comprehensive stroke centers. Multivariable mixed-effects logistic regression models were performed assessing the association of tenecteplase with symptomatic intracranial hemorrhage and independent outcome (modified Rankin Scale score, 0-2) at day 90.Results:There were 165 patients treated with tenecteplase and 254 with alteplase. Age (75 versus 74 years), sex (56% versus 60% male), National Institutes of Health Stroke Scale scores (8 versus 10), median door-to-needle times (47 versus 48 minutes), or onset-to-needle time (129 versus 130 minutes) were similar between the groups. Symptomatic intracranial hemorrhage occurred in 3 (1.8% [95% CI, 0.4-5.3]) tenecteplase patients compared with 7 (2.7% [95% CI, 1.1-5.7]) alteplase patients (P=0.75). There were no differences between tenecteplase and alteplase in the rates of angioedema (4 [2.4%; 95% CI, 0.7-6.2] versus 1 [0.4%; 95% CI, 0.01-2.2], P=0.08) or 90-day functional independence (100 [61%] versus 140 [57%], P=0.47), respectively. In mixed-effects logistic regression models, there was no significant association between thrombolytic choice and symptomatic intracranial hemorrhage (odds ratio tenecteplase, 0.62 [95% CI, 0.14-2.80], P=0.53) or functional independence (odds ratio tenecteplase, 1.20 [95% CI, 0.74-1.95], P=0.46).Conclusions:Routine use of tenecteplase for stroke thrombolysis was feasible and had comparable safety profile and outcome to alteplase.