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Intravenous Tenecteplase Compared with Alteplase for Acute Ischaemic Stroke in Canada (AcT): A Pragmatic, Multicentre, Open-Label, Registry-Linked, Randomised, Controlled, Non-Inferiority Trial

By Currents Editor posted 09-13-2022 09:18

  

The Lancet (07/16/22) Vol. 400, No. 10347, P. 161, DOI: 10.1016/S0140-6736(22)01054-6
Menon, BK; Buck, BH; Singh, N; et al.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01054-6/fulltext 

Research conducted in Canada explored tenecteplase as an alternative to alteplase in intravenous thrombolysis for the treatment of acute ischemic stroke. Approximately one-half of the study's 1,600 adult participants were randomly assigned to standard care, defined as a bolus of 0.9 mg/kg alteplase followed by an hour-long infusion of up to 0.81 mg/kg. The remaining patients were allocated to a single bolus of 0.25 mg/kg tenecteplase, up to 25 mg total. The share of participants in each cohort who achieved a modified Rankin Scale score of 0–1 within 90–120 days was similar, at respective rates of 36.9% and 34.8%. The unadjusted risk difference of 2.1% fell within the boundaries of a prespecified margin of -5% to establish noninferiority. Safety outcomes were also similar between the two groups. Based on the data, the study authors consider intravenous tenecteplase at a dose of 0.25 mg/kg to be a viable substitute for alteplase in patients with acute ischemic stroke who are eligible for thrombolysis.

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