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HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

172 - Battle of the Clot Busters: Alteplase vs. Tenecteplase for Acute Ischemic Stroke

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5644 Ratings

🗓️ 10 October 2023

⏱️ 36 minutes

🧾️ Download transcript

Summary

In this episode, we review the role and indications of thrombolytics in acute ischemic stroke. The efficacy, safety, administration considerations, and cost between alteplase and tenecteplase are compared and contrasted.

Key Concepts

  1. Alteplase (Activase) is a recombinant DNA version of human TPA (tissue plasminogen activator). Tenecteplase (TNKase) is similar to human TPA except it has three amino acid changes that result in a longer half-life and higher fibrin specificity.
  2. In patients with stroke, alteplase is given as a bolus followed by a 60-minute infusion. Tenecteplase is given as an IV bolus without the need for an infusion due to its longer half-life.
  3. Tenecteplase is at least as safe and effective as alteplase in acute ischemic stroke (with some studies showing greater benefit with tenecteplase).
  4. In patients with acute ischemic stroke who are candidates for mechanical thrombectomy, thrombolytics (with alteplase or tenecteplase) will still be given in patients who meet inclusion criteria and have no exclusion criteria.

References

  • Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [published correction appears in Stroke. 2019 Dec;50(12):e440-e441]. Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211
  • Campbell BCV, Mitchell PJ, Churilov L, et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med. 2018;378(17):1573-1582. doi:10.1056/NEJMoa1716405
  • Kobeissi H, Ghozy S, Turfe B, et al. Tenecteplase vs. alteplase for treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized trials. Front Neurol. 2023;14:1102463. Published 2023 Jan 23. doi:10.3389/fneur.2023.1102463

Transcript

Click on a timestamp to play from that location

0:00.0

Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.

0:11.0

This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.

0:17.0

This podcast contains general information for educational purposes only. This is not professional

0:22.4

advice and should not be used in lieu of obtaining advice from a qualified health care provider.

0:27.2

And now on to the show.

0:31.2

Welcome to Helix Talk episode 172. I'm your co-host Dr. Kane. And I'm Dr. Patel.

0:36.8

And the title of today's episode is Battle of the Clot Busters, Altaplase versus Tenectaplace for acute ischemic stroke stroke.

0:44.7

So today we're clearly talking about two commonly used drug therapies for acute ischemic stroke management.

0:51.3

And Dr. Patel, this has become a really hot topic.

0:53.7

Our hospital system has recently

0:55.5

actually switched from Altaplase to Tenectaplace, and I'm guessing many other hospital systems are also

1:01.2

either making the move or contemplating the move. So based on that, the logical question is,

1:06.7

why are we doing this and what do we need to know about this newer drug, Tenectopace for acute ischemic stroke?

1:12.0

And I believe this was our listener requested topic.

1:15.4

It was.

1:16.0

Yeah, we got a request about this.

1:18.3

And, you know, for any listener that has their own topic that they would like to know more

1:22.5

about, you're welcome to contact us at helixtalk.com or on Twitter at Helix Talk.

1:29.4

So really, the nature of today's episode is to talk about what is the difference between altiplase versus tenecta place? Is one more

1:34.6

effective? Is one safer? One cheaper. What is the evidence to support tenectoplastapace? Like,

1:40.6

clearly there must be some evidence to dethrone the king of Altaplace, which we've had for a really long time.

1:46.9

And then really, what do pharmacists and other health care providers need to know about the use of thrombolytics, TPA, and acute ischemic strokes?

...

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