Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital

Comprehensive Review of Tenecteplase for Thrombolysis in Acute Ischemic Stroke

Although intravenous thrombolysis with alteplase remains the primary treatment for acute ischemic stroke, tenecteplase has shown potential advantages over alteplase. Animal studies have demonstrated the favorable pharmacokinetics and pharmacodynamics of tenecteplase. Moreover, it is easier to administer. Clinical trials have demonstrated that tenecteplase is not inferior to alteplase and may even be superior in cases of acute ischemic stroke with large vessel occlusion. Current evidence supports the time and cost benefits of tenecteplase, suggesting that it could potentially replace alteplase as the main option for thrombolytic therapy, especially in patients with large vessel occlusion.

[Thrombolysis alert in ischemic stroke: experience of the international private clinic Al Badie in Fez (cross-sectional study of 60 cases)]

Intravenous thrombolysis is the standard treatment for acute ischemic stroke. We here report the cases of thrombolysis alert in the private sector in Morocco We conducted a prospective study of all patients with neurological deficit of sudden onset occurred within the first 12 hours admitted to the Emergency Department of the Al Badie international private clinic from January 2022 to September 2023. Epidemiological, clinical and etiological characteristics as well as data on outpatient and inpatient delays were collected. Sixty patients were included in the study. The average admission delay was 198.36 ± 79.23 minutes. The mean NIHSS (National Institutes of Health Stroke Scale) score was 10.41 ± 4.97. The average time for imaging was 26.68 ± 9.63 minutes. Ischaemic stroke was the most common diagnosis (85%), followed by "stroke mimics" (11.6%). Thirteen patients underwent thrombolysis with tenecteplase. The mean time from admission to the initiation of thrombolysis was 107.15 ± 24.48 minutes. Follow-up imaging at 24 hours post thrombolysis revealed symptomatic haemorrhagic transformation in 3 patients. Six patients were transferred to the Hassan II University Hospital for thrombolysis and/or mechanical thrombectomy. After 3 months, 4 patients were autonomous (Rankin score changed between 0 and 2). Our experience shows that it is imperative to reduce outpatient and inpatient delays in treatment in order to increase the proportion of patients treated with thrombolysis.

The use of intravenous thrombolytics in acute ischemic stroke management: A scoping review from 2008 till 2021 in the Arab world in the Middle East and North Africa

OBJECTIVE

The aim of this review was to assess and analyze the research output on intravenous thrombolysis in acute ischemic stroke in the Arab world in the Middle East and North Africa.

METHODS

Published literature on intravenous thrombolysis for acute ischemic stroke from 2008 to 2021 were retrieved from several electronic databases. Extracted records were analyzed in terms of year of publication, country, journal, research area, authors, and organizational affiliations.

RESULTS

A total of 37 studies were published between 2008 and 2021 from different Arab countries. Eight studies assessed the safety and efficacy of thrombolytic agents in AIS. Three studies were KAP studies addressing the knowledge, attitude and practice towards IVT. The majority of the selected studies (n=16) discussed the utilization rate of IVT among patients in different hospital settings across these countries. Ten studies reported the outcomes associated with the use of IVT for AIS.

CONCLUSION

This is the first scoping review to study the research activity related to the use of IVT in stroke in the Arab nations. In the last 15 years, stroke research productivity was very low in the Arab world compared to other regions of the world due to several impeding factors. Given the high burden of in-adherence to acute stroke treatment in the Arab nations, there is a serious need for an increased high-quality research activity to highlight the roadblocks associated with the limited use of IVT.

Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis

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.

Effectiveness and safety of different doses of tenecteplase in the treatment of acute ischemic stroke: A protocol for systematic review and meta-analysis

BACKGROUND

Tenecteplase is a modified recombinant tissue-plasminogen activator, which is effective and safe in the treatment of acute ischemic stroke. However, the therapeutic dose of tenecteplase has been controversial. The purpose of this study is to systematically investigate the efficacy and safety of different doses of tenecteplase thrombolytic therapy for acute ischemic stroke.

METHODS

Computer retrieval of English databases (PubMed, EMBASE, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wanfang, Viper, and Chinese Biomedical Database) is conducted for a randomized controlled clinical study on thrombolytic treatment of acute ischemic stroke with different doses of tenecteplase from the establishment of the database to October 2020. Two researchers independently conduct data extraction and literature quality evaluation on the quality of the included studies, and meta-analysis is conducted on the included literatures using RevMan5.3 software.

OUTCOME

In this study, National Institute of Health Stroke Scale (NIHSS) score, Modified Rankin Scale (mRS) score scale, symptomatic intracranial hemorrhage (SICH) incidence, All-cause mortality, and so on are used to evaluate the efficacy and safety of tenecteplase thrombolytic therapy in acute ischemic stroke with different doses.

CONCLUSION

This study will provide reliable evidence-based evidence for the clinical application of different doses of tenecteplase in thrombolytic therapy for acute ischemic stroke.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/2MPCW.

Ischemic stroke in Morocco: a systematic review

Background

The aim of this systematic review is to determine the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.

Methods

The present work is a systematic review that was conducted according to the recommendations of the “Preferred reporting items for systematic reviews and meta-analysis”. We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the time frame 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206).

These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10,172 in Acute Stroke Treatment, prehospital delay average and its influential factors, thrombolyzed patients’ proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco.

Results

Twenty-nine (n = 29) studies were selected. The average age ranged from 49 ± 15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by the prementioned studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 h. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies, which were conducted in hospital environment, have a reduced sample size and no confidence interval.

Conclusions

Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. This indicates the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco.

Acute ischemic stroke thrombolysis with tenecteplase: An institutional experience from South India

Objective:

Outcome assessment of intravenous (IV) thrombolysis with tenecteplase in acute ischemic stroke.

Materials and Methods:

We consecutively enrolled acute ischemic stroke patients who underwent IV thrombolysis with tenecteplase from October 2016 to May 2017. Primary clinical efficacy outcome was defined as an improvement in the National Institute of Health Stroke Scale (NIHSS) score of ≥4 points at 24 h (h). Secondary clinical efficacy outcome was the favorable outcome on modified Rankin scale at 90 days defined as a score of 0 or 1. The safety endpoints were death rate at 90 days and symptomatic intracranial hemorrhage (SICH).

Results:

Mean NIHSS scores at baseline and 24 h were 13 (±3.81) and 9.29 (±5.74), respectively, the difference being statistically significant (P = 0.016). In this study, nine patients (64%) met the primary clinical efficacy outcome and eleven (78.5%) patients met the secondary clinical efficacy outcome. Only 1 (7%) patient developed SICH and additionally, aspiration pneumonia with subsequent death.

Conclusion:

This study confirms the efficacy and safety of tenecteplase for stroke thrombolysis in our clinical setting. Tenecteplase appears to be a suitable option for stroke thrombolysis in resource-limited settings, considering its cost-effectiveness, and ease of administration.

Intravenous thrombolysis with rt-PA in stroke: experience of the moroccan stroke unit

The majority of strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred. We report the case series of all patients who were treated with rt-PA at Stroke Unit of HASSAN II University hospital between 2010 and 2013. There were 52 patients treated with intravenous rtPA during the study period. The mean age was 63 years with the no gender predominance (sex ratio 1.02). Hypertension was the most common vascular risk factor (31%) and 17% of patients suffered from atrial fibrillation. 17 of 52 patients (32.7%) were treated within a 3 hours window of stroke onset and 35 of 52 (67.3%) patients were treated within 3-4.5 h. Twenty five patients (48%) had significant early improvements within 24 hours and twenty one (40.3%) patients had good outcomes at 3 months and fifteen patients (29%) died within the same period.