According to study, researchers examine that for a stroke patients, they give the clot-busting intravenous drug alteplase, but another drug may be more effective. Among more than 200 stroke victims, TNKase (tenecteplase) was about twice as effective as alteplase in restoring blood flow to the brain, and it also resulted in less disability. The study was published in the New England Journal of Medicine.
"Tenecteplase is likely to become the preferred medication for clot-dissolving in stroke patients," said lead researcher Dr Bruce Campbell, head of the stroke department at the Royal Melbourne Hospital in Parkville. "It is likely to change stroke treatment guidelines and clinical practice," Campbell said tenecteplase is more effective than alteplase because of differences in the enzymes in each drug.
Although both drugs work in the same way, tenecteplase is better at attacking and dissolving clots, and more resistant to factors that inhibit the breakdown of clots, he said. For either drug to be most effective, it needs to be given as soon as possible after a stroke occurs. In this study, patients were given the drugs within 4.5 hours after the onset of a stroke, Campbell said. Although tenecteplase appears to be more effective for stroke patients, it's not approved for that use in the United States.
In 2000, the U.S. Food and Drug Administration approved tenecteplase for use after a heart attack, Arora said. "Tenecteplase is being widely used in developing countries, such as India," he said. "One reason is it's cheaper than alteplase." In the United States, tenecteplase costs about $5,800, versus alteplase, which costs $8,000, Arora said. Also, tenecteplase is easier to give, requiring only a single injection, while alteplase requires an injection and an IV drip, he added.
Arora explained that tenecteplase is not widely used in the United States for heart attack patients because these patients are typically treated with angioplasty or heart bypass surgery. For the new study, which did not receive drug company funding. Researchers randomly assigned 202 stroke patients to either alteplase or tenecteplase before surgery to remove clots.
Patients treated with tenecteplase also had better functional outcomes after 90 days than that given alteplase, the findings showed. Bleeding into the brain, the most serious side effect of either drug, occurred in 1% of patients, regardless of which drug they received.
The researchers specifically looked to see which drug was better at restoring blood flow to clot-blocked blood vessels in the brain, and which drug resulted in patients having better outcomes. The investigators found that 22% of the patients treated with tenecteplase had more than 50% of blood flow return to the brain, compared with 10% of those treated with alteplase.