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Sustainability of Intravenous Alteplase Administration via Telephone-Based Consult: Data from a US Health System
Despite multiple advances in management over the last few decades, acute ischemic stroke (AIS) is still associated with high morbidity and mortality.1 Intravenous alteplase (IV tPA) was shown to be efficacious and safe for AIS about a quarter century ago2 and remains the only Food and Drug Administration-approved medication for this indication. Though ideal, stroke neurologists may not be available in-person to decide whether to administer tPA to an AIS patient.
Source: Journal of Stroke and Cerebrovascular Diseases - January 27, 2022 Category: Neurology Authors: Sarah E. Nelson, Eric Aldrich, Brenda Johnson, Susan Groman, Richard E. Thompson, Victor Urrutia Source Type: research

Tenecteplase for Acute Ischemic Stroke Treatment
Semin Neurol DOI: 10.1055/s-0040-1722722The introduction of thrombolytic therapy in the 1990s has transformed acute ischemic stroke treatment. Thus far, intravenous recombinant tissue plasminogen activator (rt-PA) also known as alteplase is the only thrombolytic proven to be efficacious and approved by the United States Food and Drug Administration. But the thrombolytic agent tenecteplase (TNK) is emerging as a potential replacement for rt-PA. TNK has greater fibrin specificity, slower clearance, and higher resistance to plasminogen activator inhibitor-1 than rt-PA. Hence, TNK has the potential to provide superior lysis wi...
Source: Seminars in Neurology - January 20, 2021 Category: Neurology Authors: Baird, Alison E. Jackson, Richard Jin, Weijun Tags: Review Article Source Type: research

Acute ischemic stroke: improving access to intravenous tissue plasminogen activator.
This article gives an overview of the recent approaches pursued to improve access to alteplase for acute ischemic stroke patients. Utilization of stroke systems of care, quality metrics, and quality improvement initiatives to improve alteplase treatment rates are discussed. The implementation of Telestroke networks to improve access and timely evaluation by a stroke specialist are also reviewed. Lastly, this review discusses the use of neuroimaging techniques to identify alteplase candidates in stroke of unknown symptom onset or beyond the 4.5-hour treatment window.Expert commentary: Expanding access to alteplase therapy f...
Source: Expert Review of Cardiovascular Therapy - April 25, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Using Tenecteplase for Acute Ischemic Stroke: What Is the Hold Up?
Alteplase is the only Food and Drug Administration-approved intravenous (IV) thrombolytic medication for acute ischemic stroke. However, multiple recent studies comparing tenecteplase and alteplase suggest that tenecteplase is at least as efficacious as alteplase with regards to neurologic improvement. When given at 0.25 milligrams per kilogram (mg/kg), tenecteplase may have less bleeding complications than alteplase as well. This narrative review evaluates the literature and addresses the practical issues with regards to the use of tenecteplase versus alteplase for acute ischemic stroke, and it recommends that physicians ...
Source: Western Journal of Emergency Medicine - February 24, 2020 Category: Emergency Medicine Source Type: research

ICU Nursing Care of the Stroke Patient
Almost 25 years ago, in June 1996, the Food and Drug Administration (FDA) approved intravenous (IV) Alteplase as the only acute drug therapy for ischemic stroke. It remains the mainstay drug to date and revolutionized Neurology, Stroke, and Neurocritcal Care. In 2013, the success of several mechanical thrombectomy studies proved the efficacy of endovascular thrombectomy for large vessel occlusions (LVO), both alone and in combination with IV Alteplase. The expanded time window opened this treatment option to a greater number of patients, who are now surviving with fewer deficits.
Source: Critical Care Nursing Clinics of North America - February 1, 2020 Category: Nursing Authors: Mary P. Amatangelo Tags: Preface Source Type: research

Choosing the Correct “-ase” in Acute Ischemic Stroke: Alteplase, Tenecteplase, and Reteplase
Alteplase is a tissue plasminogen activator approved for treating acute ischemic stroke (AIS), acute myocardial infarction (AMI), and acute massive pulmonary embolism. Two additional tissue plasminogen activators, tenecteplase and reteplase, are also approved for AMI treatment. However, neither tenecteplase nor reteplase is approved for AIS treatment. The U.S. Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can lead to potential overdose. Primary factors contributing to medication errors include use of the abbreviat...
Source: Advanced Emergency Nursing Journal - July 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research

Nerve stimulation could provide new treatment option for most common type of stroke
Research led by a UCLA scientist found that a new nerve stimulation therapy to increase blood flow could help patients with the most common type of stroke up to 24 hours after onset.A study of 1,000 patients found evidence that the technique, called active nerve cell cluster stimulation, reduced the patients ’ degree of disability three months after they suffered an acute cortical ischemic stroke, which affects the surface of the brain.Dr. Jeffrey Saver, director of theUCLA Comprehensive Stroke Center, was the co-principal investigator of the study, which was conducted at 73 medical centers in 18 countries.“We believe ...
Source: UCLA Newsroom: Health Sciences - May 24, 2019 Category: Universities & Medical Training Source Type: news

Making a case for the right "-ase" in acute ischemic stroke: alteplase, tenecteplase, and reteplase.
Authors: Wyatt Chester K, Corrigan M, Schoeffler JM, Shah M, Toy F, Purdon B, Dillon GM Abstract INTRODUCTION: Alteplase, reteplase, and tenecteplase are tissue plasminogen activators (TPA) approved for the management of acute myocardial infarction. Only alteplase is also approved for the treatment of acute ischemic stroke (AIS). The US Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can result in failure to treat patients with the intended agent and lead to potential overdose. Areas covered: This review com...
Source: Expert Opinion on Drug Safety - February 5, 2019 Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research

Relevance of the Updated Food and Drug Administration Alteplase Label for Acute Ischemic Stroke: The Estimated Impact and Current Guidelines.
Abstract In 2015, the Food and Drug Administration updated the contraindications for the use of alteplase in acute ischemic stroke (AIS), potentially creating a greater impact on treatment. A history of intracranial hemorrhage and recent stroke within 3 months were removed as contraindications, increasing the number of patients eligible for alteplase. The aim of this commentary is to call attention to the updates and discuss them relative to current American Heart Association/American Stroke Association guidelines. Additionally, we estimate the clinical impact of the updates by analyzing AIS admissions to a large-...
Source: The Annals of Pharmacotherapy - January 1, 2018 Category: Drugs & Pharmacology Authors: Shiue HJ, Albright KC, Sands KA Tags: Ann Pharmacother Source Type: research

Alteplase Treatment in Acute Stroke: Incorporating Food and Drug Administration Prescribing Information into Existing Acute Stroke Management Guide
Abstract Despite strong evidence that intravenous tissue plasminogen activator (tPA) improves outcomes in acute ischemic stroke patients, its use in clinical practice remains modest. Complex eligibility criteria have been postulated as barriers to greater utilization. Further complicating this has been multiple guidelines and prescribing labels that have been published since first being approved for use in 1996. In this review, several warning and exclusion criteria for tPA in acute ischemic stroke are reviewed with the goal of providing readers a nuanced understanding of historical context and available evidence...
Source: Current Atherosclerosis Reports - June 29, 2016 Category: Cardiology Source Type: research

Seeking an alteplase alternative for stroke
Where is a biosimilar when you need one? A few weeks ago, I reported on an advisory committee of the Food and Drug Administration overwhelmingly recommending that the agency approve a biosimilar...
Source: Family Practice News - March 8, 2016 Category: Primary Care Source Type: news

Tissue-type plasminogen activator-binding RNA aptamers inhibiting low-density lipoprotein receptor family-mediated internalisation.
Abstract Recombinant tissue-type plasminogen activator (tPA, trade name Alteplase), currently the only drug approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of cerebral ischaemic stroke, has been implicated in a number of adverse effects reportedly mediated by interactions with the low-density lipoprotein (LDL) family receptors, including neuronal cell death and an increased risk of cerebral haemorrhage. The tissue-type plasminogen activator is the principal initiator of thrombolysis in human physiology, an effect that is mediated directly via localised activation...
Source: Thrombosis and Haemostasis - April 9, 2015 Category: Hematology Authors: Bjerregaard N, Bøtkjær KA, Helsen N, Andreasen PA, Dupont DM Tags: Thromb Haemost Source Type: research

Successful Intra-arterial Thrombolysis in a Patient with an Intracranial Meningioma
We report a case of a 78-year-old man who was seen in our emergency department within 2 hours from sudden onset of aphasia, right-sided hemiplegia, hypoesthesia, and homonymous hemianopsia. The National Institutes of Health Stroke Scale (NIHSS) score at admission was 20. Intra-arterial thrombolysis was performed with administration of .3 mg/kg of alteplase combined with mechanical thrombectomy. At discharge, his NIHSS score was 1, and after 90 days, his modified Rankin score was 1. To our knowledge, this is the first report of intra-arterial thrombolysis in a patient with acute ischemic stroke with an intracranial tumor.
Source: Journal of Stroke and Cerebrovascular Diseases - July 8, 2013 Category: Neurology Authors: Robson F. Baiense, Agessandro Abrahão, Irapuá F. Ricarte, Thiago G. Fukuda, Ricardo A. Oliveira, Gisele S. Silva, Maristela Costa, Manoel J. Teixeira Tags: Case Reports Source Type: research