Transition to Tenecteplase From t-PA for Acute Ischemic Stroke at Walter Reed National Military Medical Center

Background: Tissue plasminogen activator (t-PA) has been the standard IV thrombolytic drug used in acute ischemic stroke treatment since 1995. Tenecteplase has been available for use in acute myocardial infarction and has been endorsed by the American Heart Association stroke guidelines as an alternative to t-PA. Observations: A systematic process to safely transition from t-PA to tenecteplase for acute ischemic stroke was undertaken at Walter Reed National Military Medical Center. The process to implement tenecteplase required extensive training and education for staff physicians, nurses, pharmacists, radiologists, trainees, and the rapid response team. There are a variety of benefits and implementation challenges to consider when transitioning thrombolytic therapy for institutional use in acute ischemic stroke. Conclusions: Evidence supports the transition from t-PA to tenecteplase for acute ischemic stroke. Successful transition required months of preparation involving multidisciplinary meetings that included neurology, nursing, pharmacy, radiology, rapid response teams, critical care, and emergency medicine. Safeguards must be implemented to avoid dosing errors that can lead to life-threatening adverse events.