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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, May 12, 2023


emDOCs / 52 in 52 – #34 - May 11, 2023 - By Brannon Inman
Reviewed by: Alex Koyfman; Brit Long
Source Article: Campbell BCV, Mitchell PJ, Churilov L, et al; EXTEND-IA TNK Investigators. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med. 2018 Apr 26;378(17):1573-1582. doi: 10.1056/NEJMoa1716405. PMID: 29694815.
Take Aways:
  • TNK is non-inferior to TPA for vessel re-cannulation and thrombus/embolus obliteration during index intervention.
  • This was an open label study, and thus physicians and other staff were not blinded to randomization.
  • As these patients were required to have arterial puncture within 6 hours of stroke onset, these data may not apply to patients who are not presenting to a stroke center. For example, a patient with an LVO stroke presenting to a hospital and needing transfer for endovascular thrombectomy, or a patient getting endovascular thrombectomy within 24 hours.
  • Prespecified superiority analysis suggests TNK may result in better functional outcomes. However, ultimately this study was powered and conducted as a non-inferiority study, so this is only hypothesis-generating.
  • This study did change its enrollment criteria after 80 patients were already enrolled.
  • There existed a substantively larger proportion of patients with MCA occlusion in the TNK arm. Given the smaller infarct territory, this could reasonably be expected to have consequential impacts on long term outcomes.