Scientific Poster Session IV: Late-Breaking Original Research

Late Breaking Original Research
  Tuesday, November 14, 2023
  08:30 AM–10:00 AM

Abstract

Introduction: Alteplase and tenecteplase are administered in ischemic stroke and massive pulmonary embolism (PE) to attempt reperfusion of vessels but carry serious concerns for increased bleed risk. Ballad Health recently adopted tenecteplase as the formulary thrombolytic.

Research Question or Hypothesis: The purpose of this study is to compare the incidence of bleeding with tenecteplase versus alteplase within Ballad Health facilities.

Study Design: This was a retrospective, observational cohort study.

Methods: This study included adults who received tenecteplase or alteplase from October 1, 2020 through May 31, 2023. All tenecteplase patients who met inclusion criteria were analyzed. To balance the cohorts, alteplase patients were randomized 1:1 to tenecteplase patients. The primary outcome was a bleeding composite including incidence of major bleed per the International Society on Thrombosis and Hemostasis (ISTH), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH). Secondary outcomes included incidence of symptomatic ICH, in-hospital mortality, administration of reversal agents, and length of stay. Mann Whitney-U testing was utilized for analysis of continuous data and Chi-Squared or Fisher’s Exact for dichotomous data.

Results: In each cohort, 175 patients were analyzed. No statistically significant difference in the bleeding composite was found, although 13% of alteplase patients versus 15% of tenecteplase patients experienced bleeding. More patients in the tenecteplase cohort experienced symptomatic ICH and required initiation of massive transfusion protocol, however neither outcome was statistically significant. Incidence of in-hospital mortality, thrombolytic reversal, and length of stay were similar between the cohorts. Subgroup analysis of 45 massive PE patients revealed higher rates of the bleeding composite in the tenecteplase cohort, 14% alteplase versus 21% tenecteplase (p-value 0.5665).

Conclusion: This study did not demonstrate a statistically significant difference in bleeding. However, these results suggest there may be reason for concern in patients treated with tenecteplase in the setting of massive PE. Larger studies are required to confirm these findings.

Presenting Author

Jacquelyn Crawford PharmD
Ballad Health

Authors

Jennifer Tharp PharmD, BCPS, BCCCP
Johnson City Medical Center

Vera Wilson PharmD, BCPS, BCCCP
Ballad Health

Austin Roe PharmD
Ballad Health