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Dr. Vojtech Novotny from the European Stroke Association recently gave all participants of the Online Lecture Series a great insight in the latest developments in stroke treatment involving the use of Tenecteplase and Alteplase.
He explained that some of the desirable characteristics of all thrombolytic agents include an extended half-life to prevent re-thrombosis, resistance to tPA inactivation, high specificity for fibrin to minimize hemorrhagic complications, and limited blood-brain barrier permeability to avert neurotoxic effects. While historically, Alteplase was introduced before Tenecteplase (TNK) and has been widely used in clinical settings, the lattereffectively fulfills the desired features and even outmatches Alteplase in some of them. Additionally, Tenecteplase only requires a single bolus administration, offering numerous advantages such as reduced door-to-needle time, decreased dosing errors, and elimination of infusion pumps.
Recent trials comparing Tenecteplase to Alteplase have demonstrated good efficacy, comparable or even improved safety, and promising results in late-window trials. Tenecteplase has therefore gained strong support as a safe and effective alternative to Alteplase in the ESO guidelines of 2023. Interestingly, Tenecteplase is even suggested over Alteplase for prehospital management to enhance early reperfusion rates and expedite the time from imaging to intervention. Additionally, when evaluating the cost-effectiveness of Tenecteplase, existing data suggests that due to time and equipment savings, it proves to be a more cost-effective option than its alternatives.
Dr. Vojtech also touched upon the limited data and recommendations available for Tenecteplase when dealing with special patient groups, such as children or geriatric patients. More data from additional trials are anticipated in late 2023, but real-life usage will provide a more comprehensive understanding of Tenecteplase’s benefits and risks.
In summary, the presentation recommended the use of 0.25 mg/kg Tenecteplase for stroke patients. However, some significant questions remain unanswered, particularly regarding its application in specific patient populations and when managing comorbidities and prior anti-thrombotics
The lecture concluded with an interactive discussion and provided a great platform for sharing experiences and knowledge.