Abstract WP42: Transition to Tenecteplase: A Regional Experience

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Background: Timely recognition and treatment of acute ischemic stroke is well-supported to promote better outcomes. Historically, alteplase has been the drug of choice for thrombolytic treatment, and while it is an excellent drug, there were barriers that would routinely come up during administration. Following the results of several studies that compared alteplase to tenecteplase, our leadership team decided to initiate the transition to tenecteplase within our region, spanning several states with approximately 40 hospitals. Purpose: The purpose of this clinical initiative was to implement tenecteplase as the primary thrombolytic in acute ischemic stroke and evaluate time to treatment (door in door out [DIDO] and door to needle [DTN]). Methods: Following the approval by leadership, the first step was identification of stakeholders at facility, market, service-line, and regional levels and initiation of bi-weekly meetings. The project relied heavily on facility-level structure that facilitates stroke quality improvement. We were able to utilize market specific stroke databases to understand historical data and to monitor ongoing success and complications. Results: Post-implementation, several positive changes were noted, which are visualized in the graphs. Conclusions: Through reduction of DIDO, treatment is initiated sooner to reperfuse at-risk brain tissue. Further evaluation is needed on the correlation between the transition and decreased length of stay, but we recognize tenecteplase has been shown to have a better rate of recanalizing large vessel occlusions, potentially resulting in less disability and shorter hospitalizations.

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