Transition to New Anti-Clot Drug Improves Patient Outcomes |  Dell School of Medicine

Transition to New Anti-Clot Drug Improves Patient Outcomes | Dell School of Medicine

AUSTIN, Texas — A next-generation clot-busting drug called tenecteplase outperforms traditional ischemic stroke treatment 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. Stroke.

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 study author and Stroke program director for Dell Med and Ascension Texas. “Based on the very early results of this study, other experts across the country were convinced and switched from alteplase to tenecteplase in their own stroke centers, including Ascension hospitals nationwide.”

Nearly 800,000 people in the United States have a stroke each year. The vast majority of these strokes (about 87%) are ischemic, that is, they occur when a vessel supplying blood to the brain is blocked by a blood clot. This can lead to a corresponding loss of neurological function.

Both tenecteplase and alteplase are federally approved for use in dissolving clots in blocked heart arteries. But the new drug tenecteplase is also being used by clinicians off-label to treat ischemic strokes, as stroke clinical trials suggest it may be at least as effective as alteplase and is easier to administer. Tenecteplase is administered as a single intravenous injection over five to 10 seconds. The researchers compared its performance with the standard stroke drug, alteplase, which is injected over 60 minutes.

“When it comes to treating stroke patients, every second counts,” said Warach, who is also a professor of neurology at Dell Med. “The shorter preparation and injection time with tenecteplase not only eliminates many dosing errors associated with alteplase, but it is also more efficient. We were able to administer the anti-clot medication 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 anti-clot, we were able to initiate transfer earlier in those treated with tenecteplase.

For patients presenting to the emergency room after a stroke, Warach’s study found that the “needle door” time – the time between when patients arrive and when they receive treatment – averaged six minutes. faster with tenecteplase. And for patients who also required a thrombectomy, the surgical removal of a blood clot that caused the stroke, tenecteplase sped up the process of transferring the patient to a stroke center capable of thrombectomy by 25 minutes. .

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

  • A 5% increase in the number of patients able to walk independently when discharged from hospital to home.
  • A 4% decrease in the occurrence of serious events such as cerebral hemorrhages, palliative care discharges or deaths.

Third major improvement: the 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 magnitude of savings could amount to more than $150 million each year in the United States,” said David Paydarfar, MD, study co-author and chair of the Department of Neurology. by Dell Med. “It’s a great example of value-based care – better care for less money.”

The Dell Med Neurology Stroke Program is currently working with colleagues from the state-funded Lone Star Stroke Research Consortium to disseminate the results of its study statewide, helping more stroke centers switch to tenecteplase. . Warach is also working with colleagues at Lone Star Stroke to create a statewide database to further confirm their findings and answer lingering questions.

“For example, we have such a large Latinx population in Texas. I would like to know if we see the same benefits of tenecteplase in this community as we are in the general population,” Warach said. “The more data we have, the more questions we can answer.”

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