Abstract DP327: Freezing Tenecteplase Aliquots Reduces Cost and Achieves Similar Outcomes in Acute Ischemic Stroke Patients

Introduction: Reconstituted tenecteplase (TNK) that is stored as frozen aliquots, then thawed has been demonstrated to be stable and maintain similar biologic activity as newly reconstituted TNK. A recent study demonstrated a reduction in waste without delaying TNK administration times in stroke patients. Although, the quantification of savings and outcomes of using previously frozen TNK in stroke are unclear. We aimed to examine cost savings and clinical outcomes when using previously frozen TNK in acute ischemic stroke patients. Methods: This is a multicenter respective analysis. In March 2022 we began dividing the 50mg vial of TNK into two frozen 25mg aliquots. From March 2022 to May 2025, data were compared between patients receiving freshly reconstituted TNK and those receiving previously frozen TNK. Descriptive statistics were used to evaluate cost-savings. Our primary clinical outcome was 90-day functional outcome (mRS) analyzed with a proportional odds logistic regression model that was adjusted for age, baseline mRS, NIHSS, duration between last known well to TNK administration and if the patient received endovascular thrombectomy. Secondary clinical outcomes included symptomatic intracranial hemorrhage (sICH) defined by SITS-MOST criteria. Results: During the study, 89 vials of TNK were frozen into 178 aliquots. A total of 126 (71%) frozen aliquots were thawed and used, resulting in savings of $279,369. There were 279 patients who received TNK and after exclusions, 277 patients (151 fresh TNK; 126 previously frozen TNK) were included in this study. Patients who received previously frozen TNK were associated with similar 90-day functional outcomes to patients receiving freshly reconstituted TNK, adjusted common Odds Ratio ( OR ) = 1.35[ 95%CI , 0.86 to 2.10], P =0.19. There were no differences in sICH rates between fresh TNK 6 (4.0%) and previously frozen TNK 7 (5.6%), adjusted OR = 1.50[ 95%CI 0.49 to 4.62], P =0.48. Conclusions: A significant cost-savings may be achieved by freezing 50mg vials of TNK into 25mg aliquots. Patients receiving previously frozen TNK were associated with similar outcomes as patients receiving freshly reconstituted TNK.