New Front-Line Drug Therapy for Stroke Patients Provides Vital Benefits

Since 1995, patients arriving at a hospital within 4.5 hours of onset of stroke symptoms have been treated with alteplase, a type of tPA medication which is a clot-busting solution used to treat ischemic strokes — the most common type.

But administering alteplase requires an intravenous (I.V.) setup and infusion pump that draws fluid from a bag and controls the rate of flow. The complex setup makes it challenging to transfer patients for additional testing or between medical facilities.

Now, a new tPA drug therapy to break up or dissolve blood clots is being used in place of alteplase. It’s called Tenecteplase and it offers many advantages. It can be administered via a single large injection, with no I.V. setup required. It carries a longer “half-life,” which means it remains in the bloodstream for a longer period of time.

Felipe De Los Rios La Rosa, M.D., stroke program director at Baptist Health’s Miami Neuroscience Institute.

And most importantly, it has been proven in studies to open clots better, both small and large clots, explains Felipe De Los Rios La Rosa, M.D., stroke program director at Baptist Health’s Miami Neuroscience Institute. Under his leadership, the stroke program has undergone three Joint Commission re-certifications as a Comprehensive Stroke Center.

Baptist Health has started utilizing Tenecteplase as the front-line treatment for stroke patients who come in during that critical time window, and allowing easier and safer transfer of patients, if needed.

“Tenecteplase has a much longer half-life and it’s just a bolus (a single dose given by injection) — and that is already a great advantage, specifically for transfers, because there are no pumps and the preparation is actually quite quick, so you don’t have to spend much time preparing the medication,” said Dr. De Los Rios La Rosa, who has been director of the stroke program at Baptist Hospital of Miami since 2016, and now leads this position as a member of Baptist Health Medical Group.

Not needing an I.V. for what could be an hour-long infusion is quite beneficial. “So, if the patient needs to do further imaging, like a CT scan of the arteries, or if the patient needs fluids or anything else, you don’t have to take time to get another intravenous line set up, which can be quite challenging in some patients, and then that can delay care. So, that is a big benefit,” he said.

A major advantage of Tenecteplase is that it may help prevent hemorrhagic transformation, a common complication of acute ischemic strokes which may cause neurological deterioration in patients, said Khalid A. Hanafy, M.D., medical director of neurocritical care and research at Marcus Neuroscience Institute at Boca Raton Regional Hospital.

Khalid A. Hanafy, M.D., medical director of neurocritical care and research at Marcus Neuroscience Institute at Boca Raton Regional Hospital.

“The primary advantage of Tenecteplase over tPA is that no infusion is required,” said Dr. Hanafy. “A simple bolus and it is all done. Tenecteplase is also supposed to be more specific for thrombus (a blood clot that forms on the wall of a blood vessel) and less likely to result in hemorrhagic transformation. This makes it safer for patients.”

Alteplase has been the mainstay of thrombolytic treatment, or “clot busting” drug therapy. But over recent years, several trials have investigated alternative thrombolytic agents, including Tenecteplase, a drug which has shown help heart attack victims with reperfusion therapy — a medical treatment to restore blood flow.

“The additional benefit of Tenecteplase is its ability to open clots better — large vessel occlusion, or larger clots, not just the smaller ones,” explains Dr. De Los Rios La Rosa. “Larger clots usually affect larger arteries. And what we have seen is that Tenecteplase is able to double the rate of opening, or what we call recanalization, of these arteries.”