Until we get proper objectives like 100% recovery we get crapola like this tyranny of low expectations; reperfusion. Survivors don't care about reperfusion, that is just an intermediate step on the way to recovery. And until we get survivors in charge researchers will not change their habits to go after the only goal in stroke. 100% RECOVERY!
You're not even measuring 100% recovery! I'd fire all of you!
“What's measured, improves.” So said management legend and author Peter F. Drucker
Association of Time to Thrombolysis With Early Reperfusion After Alteplase and Tenecteplase in Patients With Large Vessel Occlusion
Abstract
Background and Objectives
Early
treatment with intravenous alteplase increases the probability of
lytic-induced reperfusion in large vessel occlusion (LVO) patients. The
relationship of tenecteplase-induced reperfusion and the timing of
thrombolytic administration has not been explored. In this study, we
performed a comparative analysis of tenecteplase and alteplase
reperfusion rates and assessed their relationship to the time of
thrombolytic administration.
Methods
Patients
who were initially treated with a thrombolytic within 4.5 hours of
symptom onset were pooled from the Royal Melbourne Stroke Registry,
EXTEND-IA, EXTEND-IA TNK, and EXTEND-IA TNK part 2 trials. The primary
outcome, thrombolytic-induced reperfusion, was defined as the absence of
retrievable thrombus or >50% reperfusion at initial angiographic
assessment (or repeat CT perfusion/angiography). We compared the
treatment effect of tenecteplase and alteplase through fixed-effects
Poisson regression modelling.
Results
Among
846 patients included in the primary analysis, early reperfusion was
observed in 173 (20%) patients (tenecteplase: 98/470 [21%],
onset-to-thrombolytic time: 132 minutes [interquartile range (IQR):
99–170], and thrombolytic-to-assessment time: 61 minutes [IQR: 39–96];
alteplase: 75/376 [19%], onset-to-thrombolytic time: 143 minutes [IQR:
105–180], thrombolytic-to-assessment time: 92 minutes [IQR: 63–144]).
Earlier onset-to-thrombolytic administration times were associated with
an increased probability of thrombolytic-induced reperfusion in patients
treated with either tenecteplase (adjusted risk ratio [aRR] 1.05 per 15
minutes [95% confidence interval (CI) 1.00–1.12] or alteplase (aRR 1.06
per 15 minutes [95% CI 1.00–1.13]). Tenecteplase remained associated
with higher rates of reperfusion vs alteplase after adjustment for
onset-to-thrombolytic time, occlusion site, thrombolytic-to-assessment
time, and study as a fixed effect, (adjusted incidence rate ratio: 1.41
[95% CI 1.02–1.93]). No significant treatment-by-time interaction was
observed (p = 0.87).
Discussion
In
patients with LVO presenting within 4.5 hours of symptom onset, earlier
thrombolytic administration increased successful reperfusion rates.
Compared with alteplase, tenecteplase was associated with a higher
probability of lytic-induced reperfusion, independent of onset-to-lytic
administration times.
Trial Registration Information
ClinicalTrials.gov Identifiers: NCT02388061, NCT03340493.
Classification of Evidence
This
study provides Class II evidence that among patients with LVO receiving
a thrombolytic, reperfusion was more likely with tenecteplase than
alteplase.
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