Background and Aims

IV rtPA is currently only thrombolytic approved for use in acute ischemic stroke (AIS) within 4.5 hours. Ongoing trials are testing efficacy of IVTenecteplase(TNK). However, TNK has been approved in India for use in AIS within 3 hours (0.2mg/kg-Max 20mg). We describe the initial experience of TNK following approval in 2016.

Objective: To determine outcome and safety of IV TNK(0.2mg/kg) in AIS
Methods: AIS patients admitted in PGIMER Emergency from April 2017 to January 2018 and administered IV TNK were included. Patients fulfilled the standard inclusions and exclusions to thrombolysis. Baseline NIHSS,proportion of patients with improvement of >4points at 24 hours, proportion of patients with modified Rankin Scale (mRS) 0-2 at 3 months was calculated. Safety was assessed from symptomatic intracerebral hemorrhage(SICH) rates asper SITS-MOST definition.Secondary efficacy measure was recanalisation rates at 24 hours of treatment.
Results: 23 patients with AIS were recruited. Mean age was 52 and 65 % were males. Baseline Median NIHSS was13, door to CT time and door to needle times were 13.5 and 50 minutes.Median ASPECT was 8,12 (52.1%) had major intracranial artery occlusion. 36% patients had >4 point NIHSS improvement at 24 hours.2 patients(8.6%) had mRS 0-2 at 1 months whilethe rest had mRS 3 - 5. 4 patients died(17.3%) and 1 patient had a SICH.5(21.7%) had recanalisation.
Conclusion IV TNK at dose of 0.2mg/kg within 3 hours of AIS although is safe but associated with poor outcomes and recanalisation rates in majority patients.Trial results should be awaited before approval of TNK as an economical alternative.

SAFETY AND OUTCOMES OF IV TENECTEPLASE IN ACUTE ISCHEMIC STROKE : INITIAL POST APPROVAL EXPERIENCE FROM TERTIARY CARE HOSPITAL IN INDIA