Monday, June 4, 2018


R.E.B.E.L.EM - June 4, 2018
"Author’s Conclusions: “Tenecteplase before thrombectomy was associated with a higher incidence of reperfusion and better functional outcome than alteplase among patients with ischemic stroke treated within 4.5 hours after symptom onset.”
Our Conclusions: Tenecteplase results in improved perfusion after thrombectomy compared to alteplase but only in patients that undergo endovascular intervention. Additionally, the rates of reperfusion prior to thrombectomy were low in both groups (22% in telecteplase vs 10% in alteplase group). There are no differences in clinically significant outcomes.
Potential Impact to Current Practice: This study only applies to a small subset of patients with strokes (ischemic, large-vessel, undergoing thrombectomy) so there is unlikely to be a difference in large population outcomes. However, hospital stroke outcomes are of increasing importance so if tenecteplase costs less and requires less time to administer, this data may lead to a shift in management.
Bottom Line: Neither alteplase or tenecteplase are very effective in significant vessel reperfusion. Though alteplase is the drug of choice currently in ischemic stroke, tenecteplase may provide more cost-effective and time-efficient option."