Coagulation and fibrinolytic activity of tenecteplase and alteplase in acute ischemic stroke

Huang, X., Moreton, F., Kalladka, D., Cheripelli, B. K., Macisaac, R., Tait, R. C. and Muir, K. (2015) Coagulation and fibrinolytic activity of tenecteplase and alteplase in acute ischemic stroke. Stroke, 46(12), pp. 3543-3546. (doi:10.1161/strokeaha.115.011290) (PMID:26514192)

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Abstract

Background and Purpose—We compared the fibrinolytic activity of tenecteplase and alteplase in patients with acute ischemic stroke, and explored the association between hypofibrinogenaemia and intracerebral hemorrhage. Methods—Venous blood samples from a subgroup of participants in the Alteplase–Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study were obtained at pretreatment, 3 to 12 hours, and 24±3 hours post-intravenous thrombolysis for analyses of plasminogen, plasminogen activator inhibitor-1, D-dimer, factor V, fibrinogen, and fibrin(ogen) degradation products, in addition to routine coagulation assays. Related sample Wilcoxon signed-rank tests were used to test the within-group changes, and independent Mann–Whitney tests for between-group differences. Results—Thirty patients were included (alteplase=14 and tenecteplase=16) with similar baseline demographics. Compared with baseline, alteplase caused significant hypofibrinogenaemia (P=0.002), prolonged prothrombin time (P=0.011), hypoplasminogenaemia (P=0.001), and lower factor V (P=0.002) at 3 to 12 hours after administration with persistent hypofibrinogenaemia at 24 hours (P=0.011), whereas only minor hypoplasminogenaemia (P=0.029) was seen in the tenecteplase group. Tenecteplase consumed less plasminogen (P<0.001) and fibrinogen (P=0.002) compared with alteplase. Conclusions—In patients with acute ischemic stroke, alteplase 0.9 mg/kg caused significant disruption of the fibrinolytic system, whereas tenecteplase 0.25 mg/kg did not, consistent with the trend toward lower intracerebral hemorrhage incidence with tenecteplase in the ATTEST study.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cheripelli, Dr Bharath Kumar and Huang, Dr Xuya and Muir, Professor Keith and Macisaac, Dr Rachael and Kalladka, Dr Dheeraj and Tait, Dr Robert and Moreton, Dr Fiona
Authors: Huang, X., Moreton, F., Kalladka, D., Cheripelli, B. K., Macisaac, R., Tait, R. C., and Muir, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:Stroke
Publisher:American Heart Association
ISSN:0039-2499
ISSN (Online):1524-4628
Copyright Holders:Copyright © 2015 American Heart Association
First Published:First published in Stroke46(12):3543-3546
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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