Tenecteplase or Alteplase: Implications for Neurological Outcome in Acute Stroke

Abstract

Purpose: To review the efficacy of Tenecteplase (TNK) versus Alteplase (TPA) in relation to neurological outcomes in the treatment of acute ischemic stroke (AIS).

Background: In acute ischemic stroke, thrombolysis has been the first-line therapy, with decades of supportive literature. Door-to-thrombolysis time has been a mainstay for stroke protocols across the country, as earlier reperfusion is linked to decreased morbidity and mortality. Currently, TPA is the only federally approved pharmacologic agent for thrombolysis in AIS; however, TNK as an alternative or even replacement has peaked interest due to its cost, administration practicality, and recent evidence of better outcomes. In this integrative literature review, we aimed to compare TNK and TPA with their respective impacts on neurological outcomes by analyzing key clinical indicators: Modified Rankin Scores (mRS), recanalization rates, and intracranial hemorrhage complications when compared to TPA.

Methods: Database searches were conducted utilizing the J. Murrey Atkins digital library, which includes CINAHL, MedLine, and PubMed databases. Selected studies were analyzed for trends within the identified clinical elements.

Results: A total of 14 studies were included. Overall, TNK was found to have higher recanalization rates, better mRS related to function, and no increased risk for intracranial hemorrhage when compared to TPA. TNK was also incidentally found to have more favorable 90-day functional outcomes.

Conclusion: Tenecteplase as a first-line agent in AIS appears to be associated with key clinical indicators related to increased neurological function; however, further studies are needed to evaluate longevity and maintenance of function.

Key words: Acute Ischemic Stroke, Alteplase, Tenecteplase, Thrombolysis

Presentation

Biography

Ashlynn Patterson BSN, CCRN

Ashlynn Patterson is a current senior MSN  AGACNP student at UNC Charlotte. She  received her BSN from East Carolina  University in 2016. She has spent the last 7  years working as a critical care nurse in the  Medical ICU at CMC-Main, and she has  been certified (CCRN) since 2018. She  serves as a preceptor, charge nurse, and  recently obtained her Clinical Nurse III.  Upon graduation, she hopes to continue her  career in critical care as a future AGAC-NP. 

Susannah Knight BSN, ADN, RN

Susannah (Annie) Knight is a current senior  AGACNP student at UNC Charlotte. She has a  previous BS degree in Nutritional Science from  North Carolina State University in 2015. She  earned her ADN from Carolinas College of  Health Sciences in 2018 and her RN-BSN from  UNC Charlotte in 2019. Her nursing career has been  spent at Atrium Health-CMC Main, specializing  in hematology and oncology with emphasis on  BMT/SCT and ICU-level care. She is an  Oncology Certified Nurse (OCN) and hopes to  continue in the specialty upon graduation.  

Amanda Kochosky BSN, ADN, RN

Amanda Kochosky is a current senior  AGACNP MSN student at UNC Charlotte. She  received her ADN at Rowan Cabarrus  Community College in 2013 and her BSN at  Cabarrus College of Health Sciences in 2021.  Most of her nursing career has been spent  specializing in advanced heart failure, cardiac  transplantation, LVADs, and total artificial  heart care. She enjoys being a resource to her  teammates and is an ACLS instructor. Upon  graduation, she plans to continue her career  caring for cardiac patients with a specialty in  advanced heart failure. 

Brent Niven BSN, RN

Brent Niven is a current senior AGACNP  MSN student at UNC Charlotte. He received a  previous BS degree in Public Health from  Clemson University in 2015. He received his  BSN from UNC Charlotte in 2020 with  Summa Cum Laude academic honors. His  nursing career has been spent in the Medical Surgical Intensive Care Unit at Atrium Health  Cabarrus as a bedside nurse, preceptor,  mentor, charge nurse, and code team nurse. He  is ACLS certified, Ultrasound IV certified,  CRRT certified, and working towards his  CCRN. Upon graduation, he plans to apply to  a critical care APP fellowship program in  hopes of becoming a critical care nurse  practitioner.  

Mollie Speight BSN, RN

Mollie Speight is a senior Family Nurse  Practitioner student at the University of North  Carolina at Charlotte. She obtained her  Bachelor of Arts Degree in Gerontology from  Winston Salem State University in 2013. She  then went on to complete an Accelerated  Bachelor of Science in Nursing program at  Duke University in 2019. She is currently  employed in the field of behavioral health,  where she has obtained certification as a  mental health nurse. Upon graduation, she  hopes to continue working in behavioral  health, specifically in the rural setting to  promote healthcare access.

Faculty Committee Advisor(s)

Florence Okoro PhD, RN