Implementation of a Tenecteplase Protocol for Treatment of Acute Ischemic Stroke in a Health System.

Innovations in pharmacy Pub Date : 2024-03-18 eCollection Date: 2024-01-01 DOI:10.24926/iip.v15i1.5801
Alexis Pace, Maya Wai, Ethan Frye
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Abstract

Purpose. Alteplase is the standard of care for intravenous thrombolytic treatment of acute ischemic stroke, but recent evidence suggests that tenecteplase may be as safe and efficacious. The purpose of this study was to evaluate the direct cost savings, safety, and efficacy outcomes following the implementation of a tenecteplase protocol for acute ischemic stroke in the emergency departments within a health system. Methods. A multicenter retrospective medical record review was performed for 4 months prior to protocol implementation on patients who received alteplase and for 4 months post-implementation on patients who received tenecteplase. The primary outcome was the direct cost difference associated with tenecteplase. Secondary outcomes included reduction in National Institutes of Health Stroke Scale 24 hours after thrombolytic therapy, door-to-needle time, symptom onset to intravenous thrombolysis time, incidence of adverse effects, and death. Results. Pre-implementation, 102 received alteplase and post-implementation, 117 received tenecteplase. Four months of utilization of tenecteplase resulted in direct cost savings of $209,476.80 for the health system, which translates to roughly $2,000 per patient. Reduction in the National Institutes for Health Stroke Scale were similar between the two groups with -3.96 in alteplase and -3.18 in tenecteplase (p = 0.952). Median door-to-needle time was 44.5 minutes in alteplase and 49 minutes in tenecteplase. Adverse events occurred in 19 patients in alteplase and 19 in tenecteplase (p = 0.573). Death occurred in 9 patients in alteplase and 14 patients in tenecteplase (p = 0.376). Conclusion. A tenecteplase protocol was successfully implemented in the healthcare system resulting in direct cost savings with no significant differences in adverse events.

在医疗系统中实施特奈替普酶治疗急性缺血性脑卒中方案。
目的。阿替普酶是急性缺血性脑卒中静脉溶栓治疗的标准疗法,但最近的证据表明替奈普酶可能同样安全有效。本研究旨在评估医疗系统急诊科实施替奈普酶方案治疗急性缺血性脑卒中后的直接成本节约、安全性和疗效。方法。在实施方案前 4 个月对接受阿替普酶治疗的患者进行了多中心回顾性病历审查,在实施方案后 4 个月对接受替奈普酶治疗的患者进行了回顾性病历审查。主要结果是与替奈普酶相关的直接成本差异。次要结果包括溶栓治疗 24 小时后美国国立卫生研究院卒中量表的降低、从门到针的时间、症状出现到静脉溶栓的时间、不良反应发生率和死亡。结果。实施前,102人接受了阿替普酶治疗,实施后,117人接受了替奈普酶治疗。使用替奈普酶四个月后,医疗系统的直接成本节省了209,476.80美元,相当于每位患者节省了约2,000美元。两组患者在美国国立卫生研究院卒中量表中的降低幅度相似,阿替普酶为-3.96,替奈替普酶为-3.18(p = 0.952)。阿替普酶的中位进针时间为44.5分钟,替奈替普酶为49分钟。阿替普酶和替奈普酶分别有19名和19名患者发生不良事件(P = 0.573)。阿替普酶有9名患者死亡,替奈替普酶有14名患者死亡(p = 0.376)。结论医疗系统成功实施了替奈普酶方案,直接节省了成本,但不良事件方面没有显著差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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