HomeHealthMedicineTransition to Newer Clot-Busting Drug Improves Patient Outcomes

Transition to Newer Clot-Busting Drug Improves Patient Outcomes

AUSTIN, Texas — A newer-generation clot-breaking drug called tenecteplase outperforms traditional treatment for ischemic strokes in several key areas, including better health outcomes and lower costs, according to a new study Published today in the Journal of the American Stroke Association Heart attack.

The study was led by a team of neurologists from Dell Medical School at the University of Texas at Austin and was conducted over a 15-month period at 10 Ascension Seton hospitals in Central Texas, beginning in September 2019.

“The Dell Med Neurology Stroke Program was one of the first in the United States to make this change,” said Steven Warach, MD, lead author of the study and director of the Stroke Program for Dell Med and Ascension Texas. “Based on even the earliest results of this study, other experts across the country were convinced and made the switch from alteplase to tenecteplase in their own stroke centers, including in Ascension hospitals nationwide.”

Almost 800,000 people in the United States have a stroke every year. The vast majority of those strokes (about 87%) are ischemic, meaning they occur when a blood vessel that supplies the brain with blood is blocked by a blood clot. This can result in a corresponding loss of neurological function.

Both tenecteplase and alteplase are federally approved for use in dissolving clots in blocked heart arteries. But the newer drug tenecteplase is also being used off-label by clinicians to treat ischemic strokes, as clinical trials in stroke suggest it may be at least as good as alteplase and easier to administer. Tenecteplase is given as a single intravenous injection lasting five to ten seconds. The researchers compared its performance with the standard stroke drug, alteplase, which is injected over 60 minutes.

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“When it comes to treating stroke patients, every second matters,” said Warach, also a professor of neurology at Dell Med. “The shorter preparation and injection time with tenecteplase not only eliminates many dosing errors related to alteplase, but is also more efficient. We were able to deliver the anticoagulant drug more quickly after patients arrived in the emergency department, and for patients who needed to be transferred to another hospital for more advanced care after receiving the anticoagulant drug, we were able to initiate the transfer earlier in those treated with tenecteplase.”

For patients arriving in the emergency department after a stroke, Warach’s study found that the “door-to-needle” time – the time between the patient’s arrival and the time they are treated – with tenecteplase averaged six minutes faster. And for patients who also needed a thrombectomy, the surgical removal of a blood clot that caused the stroke, tenecteplase sped up the process of transferring the patient to a thrombectomy stroke center by 25 minutes.

Researchers also saw improvements in clinical outcomes for patients receiving tenecteplase, including:

  • A 5% increase in patients who were able to walk independently at the time of hospital discharge and home.
  • A 4% reduction in cases of bad events such as brain haemorrhage, discharge to hospice or death.

The third big improvement: cost. The research team found that treatment with tenecteplase cost hospitals about $2,500 less than alteplase per patient.

“If this price differential continues, the size of the savings could reach more than $150 million a year in the US,” said David Paydarfar, MD, co-author of the study and chair of the Department of Neurology at Dell Med. “This is a great example of value-based care – better care for less.”

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The Dell Med Neurology Stroke Program is now partnering with colleagues in the state-funded Lone Star Stroke Research Consortium to disseminate its research findings across the state and help more stroke centers make the switch to tenecteplase. Warach is also working with Lone Star Stroke colleagues to build a national database to further confirm their results and answer lingering questions.

“For example, we have such a large Latinx population in Texas. I’d like to know if we see the same benefits of tenecteplase in that community as we do in the larger population,” Warach said. “The more data we have, the more we ask. can answer.”



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