R.E.B.E.L.EM - March 23, 2020 - By Anand Swaminathan
Article: Campbell BCV et al. Effect of intravenous tenecteplase dose on cerebral repercussion before thrombectomy in patient with large vessel occlusion ischemic stroke: The EXTEND-IA TNK Part 2 Randomized Clinical Trial. JAMA 2020. PMID: 32078683
"Clinical Question: Does higher dose tenecteplase (0.40 mg/kg) result in improved cerebral reperfusion when administered prior to endovascular therapy in LVO ischemic stroke?
Authors Conclusions:
“Among patients with large vessel occlusion ischemic stroke, a dose of 0.40mg/kg, compared with 0.25mg/kg, of tenecteplase did not significantly improve cerebral reperfusion prior to endovascular thrombectomy. The findings suggest that the 0.40-mg/kg dose of tenecteplase does not confer an advantage over the 0.25-mg/kg dose in patients with large vessel occlusion ischemic stroke in whom endovascular thrombectomy is planned.”
Our Conclusions: A higher dose of tenecteplase did not result in an improvement of the disease centered primary outcome of improved perfusion. Additionally, there was no difference in patient centered outcomes that were investigated as secondary outcomes. Though not clinically significant, there was a 3-fold increase in intracranial hemorrhage with the higher dose.
Potential to Impact Current Practice: Standard doses of systemic lytics should be continued to be used in patients presenting with LVO acute ischemic strokes who present within established timelines and are eligible for EVT. The bigger question is whether future research will show that systemic thrombolytics are unnecessary in these patients all together."