Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, April 1, 2022

Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke

 Once again you will notice they are testing the wrong endpoints; 'good functional outcome' rather than 100% RECOVERY. THIS is why survivors need to be in charge, we won't take our eyes off the only goal in stroke: 100% RECOVERY.

Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke

A Systematic Review and Meta-analysis

JAMA Netw Open. 2022;5(3):e224506. doi:10.1001/jamanetworkopen.2022.4506
Key Points

Question  How does the use of tenecteplase compare with the use of alteplase in the clinical outcomes of patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis?

Findings  In this systematic review and meta-analysis, 6 nonrandomized studies including 1820 participants were analyzed. Intravenous tenecteplase was associated with better short-term and long-term functional outcomes in patients with AIS and a higher likelihood of successful recanalization in patients with acute intracranial vessel occlusions; no increased risk of intracranial bleeding was noted with intravenous tenecteplase compared with alteplase.

Meaning  Analysis of evidence from nonrandomized studies suggests that tenecteplase is as safe as alteplase for the treatment of AIS and tenecteplase is potentially associated with more favorable outcomes.

Abstract

Importance  Tenecteplase is being evaluated as an alternative thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized clinical trials (RCTs). In addition, nonrandomized clinical experiences with off-label use of tenecteplase vs alteplase for AIS treatment are being published.

Objective  To evaluate the available evidence on the safety and efficacy of intravenous tenecteplase compared with intravenous alteplase provided by nonrandomized studies.

Data Sources  Eligible studies were identified by searching MEDLINE and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 12, 2021. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal.

Study Selection  Nonrandomized studies (prospective or retrospective) comparing intravenous tenecteplase (at any dose) with intravenous alteplase in patients with AIS were included in the analysis.

Data Extraction and Synthesis  The crude odds ratios (ORs) and 95% CIs were calculated for the association of tenecteplase vs alteplase with the outcomes of interest and adjusted ORs were extracted if provided. Estimates using random-effects models were pooled.

Main Outcomes and Measures  The primary outcome was the probability of good functional outcome (modified Rankin scale [mRS] score, 0-2) at 90 days.

Results  Six studies were identified including a total of 1820 patients (618 [34%] treated with tenecteplase). Patients receiving tenecteplase had higher odds of 3-month good functional outcome (crude odds ratio [OR], 1.22; 95% CI, 0.90-1.66; adjusted OR, 1.60, 95% CI, 1.08-2.37), successful recanalization (crude OR, 2.82; 95% CI, 1.12-7.10; adjusted OR, 2.38; 95% CI, 1.18-4.81), and early neurological improvement (crude OR, 4.88; 95% CI, 2.03-11.71; adjusted OR, 7.60; 95% CI, 1.97-29.41). No significant differences were detected in 3-month excellent functional outcome proportions (mRS score 0-1; crude OR, 1.53; 95% CI, 0.81-2.91; adjusted OR, 2.51; 95% CI, 0.66- 9.49), symptomatic intracranial hemorrhage (crude OR, 0.97; 95% CI, 0.44-2.16; adjusted OR, 1.16; 95% CI, 0.13-10.50), or parenchymal hematoma (crude OR, 1.20; 95% CI, 0.24-5.95).

Conclusions and Relevance  Evidence from nonrandomized studies suggests tenecteplase is as safe as alteplase and potentially associated with improved functional outcomes compared with alteplase. Based on these findings, enrollment in the ongoing RCTs appears to be appropriate.

 

 

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