Abstract WP196: Transition from Alteplase to Tenecteplase and the Association with Door-in-Door-out Times

Introduction: Shorter door-in-door-out (DIDO) times are associated with improved patient outcomes. This is especially important for thrombectomy-eligible patients, as a shorter DIDO time means shorter time to reperfusion. The Joint Commission recommends a DIDO goal of less than 120 minutes. Tenecteplase (TNK) has potential advantages over alteplase (tPA) given its longer half-life and easier administration delivered by intravenous push rather than a one-hour infusion. As many stroke centers are transitioning from tPA to TNK, we sought to explore whether this change was associated with a decrease in DIDO times. Methods: This is a cohort study of patients treated with IV thrombolysis (IVT) over a 36-month period (from 10/2021 to 09/2024) who were transferred for thrombectomy consideration. Our stroke system consisting of 11 hospitals transitioned from tPA to TNK in April 2023. Three system hospitals are supported by Telestroke and transfer patients to an academic Comprehensive Stroke Center. We compared these hospitals’ DIDO times between patients treated with tPA (10/2021-3/2023, 18 months) and TNK (4/2023-9/2024, 18 months). Statistical analysis was done using unpaired t-test. We also evaluated time from CTA completion to when transfer ambulance was called for dispatch. Results: Of the 450 patients who were treated with IVT, 36 patients were transferred for thrombectomy consideration (19 TNK, 17 tPA). DIDO was shorter for TNK cases, though not statistically significant (TNK: mean 169 min, median 148 min vs tPA: mean 174 min, median 162; p = 0.81). Eight patients in our cohort had data on ambulance dispatch time (3 tPA, 5 TNK); the time from CTA completion to ambulance dispatch was mean 65 mins, median 54.5 mins overall (tPA: mean 96.3, median 63; TNK: mean 46.8, median 48; p=0.24). Conclusion: In the first 18 months after roll-out, TNK did not significantly reduce DIDO times for LVO patients transferring to our academic CSC for thrombectomy. The average time from CTA completion to ambulance dispatch was 65 mins, accounting for nearly 40% of total DIDO. While this metric was shorter in TNK-treated patients, the difference was not statistically significant. This highlights the critical importance of decreasing the time from LVO identification to ambulance dispatch as a way of significantly shortening DIDO. Next steps include analysis of patients who were transferred to another CSC within our system over the same time frame.