In this episode, I’ll discuss the safety of tenecteplase in patients with stroke mimics.
Acute ischemic stroke must be treated promptly when a patient presents within the thrombolytic treatment window, but invariably, some patients who present with stroke-like symptoms will be determined to have had a different condition after they receive thrombolytic therapy. This is referred to as a “stroke mimic”. Stroke mimic conditions include Todd’s paralysis which is temporary weakness or paralysis on one side if the body after a seizure, hemiplegic migraines, hypoglycemia, or brain tumor.
With the increase in use of tenecteplase for acute ischemic stroke, a group of authors has published in Pharmacotherapy a single-center, retrospective cohort study looking at the safety of tenecteplase in stroke mimics.
Data from 250 patients presenting with stroke like symptoms at a single center who then received treatment with tenecteplase were analyzed. About 30% of these patients turned out to have stroke mimic, and not acute ischemic stroke. Intracranial hemorrhage, which is the major concern, occurred in 11.5% of the confirmed acute ischemic stroke patients and none of the stroke mimics. Discharge dispositions and cases of angioedema were similar between groups.
The authors concluded:
Tenecteplase appears safe for stroke mimics, with no disproportionate harm compared to patients with AIS. This study further supports the safety of tenecteplase in stroke mimics, aiding rapid treatment decisions in stroke-like presentations.
While only a single center’s experience, this data tracks with previous data on thrombolytics that has consistently found that intracranial hemorrhage after thrombolytic administration is much higher in patients with stroke than those with a different disease, whether it be stroke mimic or pulmonary embolism.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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