Abstract-Text (inkl. Referenzen und Bildunterschriften)

Introduction:

Acute ischemic stroke (AIS) outcomes are time-sensitive. Reducing door-to-groin (DTG) times is critical for improving patient outcomes for eligible patients admitted with AIS. Tenecteplase (TNK) has emerged as a potential alternative to alteplase (ALT) in AIS and may expedite DTG times. TNK offers advantages such as simplified administration, reduced risk of dosage errors, and suitability for a "give and go" protocol, facilitating faster patient transfer to higher stroke centers. This study compares TNK and ALT DTG times.

Methods:

Data from the Lone Star Stroke Consortium (LSSC) registry, encompassing 9 Texas hospitals were analyzed. The dataset mapped subject data to Get-With-the-Guidelines (GWTG) stroke variables and included AIS patients who received either ALT or TNK between October 2019 and March 2023. Patient data were categorized into ALT or TNK groups. Descriptive statistics and measures of central tendency were first examined. Models were constructed using the Wilcoxon signed-rank test to explore median differences in DTG times by group assignment.

Results:

Of 621 patients in the study, 459 received ALT, and 162 received TNK. Among these, 142 patients (90 ALT and 52 TNK) that presented directly to the treating center underwent endovascular thrombectomy (EVT); transfer subjects were excluded. The groups had similar mean age (69.2 [14.7]) and NIHSS scores (11.1 [7.5]; P>.05). The median DTG times were 113 min (91.5-132.8) for ALT versus 93 min (69-109.8) for TNK (Wilcoxon signed-rank Z = -2.52; P< .05).

Conclusion: TNK demonstrated superiority in reducing DTG times when compared to ALT in the treatment of eligible patients admitted with AIS. These findings suggest that TNK may lead to earlier interventions for large vessel occlusions and subsequently improve patient outcomes. Statistically significant difference is found between TNK and ALK, and the use of TNK reduces the DTG time in our study sample. This study highlights the potential benefits of adopting TNK as a thrombolytic agent in AIS treatment protocols.