Thrombolysis with tenecteplase in acute ischaemic stroke in a tertiary care setting in Sri Lanka: A retrospective study

Introduction: Alteplase (ALT) is the standard thrombolytic treatment in acute ischaemic stroke (AIS). Tenecteplase (TNK) is proven to be effective in acute coronary syndrome, is relatively cheap, widely available and can easily be given as a single intravenous (IV) bolus. Despite evidence for its use, there is equivocal guidance for the use of TNK in AIS. On the background of a global reduction in stroke admissions, treatment interventions and prolonged treatment time metrics due to the COVID-19 pandemic, this study highlights the experience with TNK in a tertiary care setting in Sri Lanka, during the pandemic.Objectives: To describe the outcomes at 48 hours among stroke patients who underwent thrombolysis with TNK at District General Hospital Hambantota, Sri Lanka over a period of one year.Methods: We retrospectively reviewed records of adults with AIS thrombolysed with 0.25 mg/kg TNK. The National Institutes of Health Stroke Scale (NIHSS) was assessed on admission and at 24-hours following treatment. Patients were observed for 48-hours for potential adverse events.Results: We thrombolysed 20 consecutive patients over one-year. The baseline mean NIHSS was 9.7 (standard deviation (SD)=4.4; range 4-22), and the 24h-post thrombolysis mean NIHSS was 6.0 (SD=7.3; range 0-28). Seventy percent (n=14) showed an improved NIHSS of at least 1-point after thrombolysis (mean difference=3.7; SD=6.46), and 55%(n=11) displayed a major clinical improvement (change in NIHSS ≥ 4). Ten percent (n=2) developed major adverse effects (one intra-cranial haemorrhage; one haemorrhagic transformation). There were no deaths.Conclusions: TNK 0.25mg/kg for the treatment of AIS appeared efficacious and safe in our case series. The limitation in this study was the low number of patients who underwent thrombolysis during the study period, as a probable effect of the COVID-19 pandemic. Thrombolysis with TNK could be a cost-effective alternative to alteplase in resource-limited South Asian settings.