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26 CSC StrokeFM Time to AcT
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In this episode, we interview Dr. Bijoy Menon (PI) and Dr. Rick Swartz (Co-PI), and we delve into the AcT trial, a study conducted to evaluate the efficacy of tenecteplase compared to alteplase for treating acute ischemic stroke. The trial involved 1,600 participants, with a median follow-up duration of 97 days.
The participants, who were all 18 years or older and had suffered an acute ischemic stroke within 4.5 hours of symptom onset, were randomly divided into two groups. Group one (816 patients) received intravenous tenecteplase (0.25 mg/kg, maximum of 25 mg), and group two (784 patients) received intravenous alteplase (0.09 mg/kg bolus, followed by a 60-minute infusion of the remaining 0.81 mg/kg).
The primary outcome measured was the modified Rankin Scale score of 0 or 1, which indicates no significant disability. This was achieved by 36.9% of patients in the tenecteplase group compared to 34.8% in the alteplase group, establishing tenecteplase's noninferiority (p for superiority = 0.19).
Secondary outcomes, such as intracerebral hemorrhage, were similar in both groups, with 3.4% in the tenecteplase group and 3.2% in the alteplase group.
The conclusion drawn from the AcT trial is that tenecteplase was noninferior to alteplase in preserving neurological function in patients with acute ischemic stroke. Due to its ease of administration, tenecteplase may become a preferred treatment option.
This episode is based on the study "Intravenous tenecteplase compared with alteplase for acute ischemic stroke in Canada (AcT): a pragmatic, multicenter, open-label, registry-linked, randomized, controlled, non-inferiority trial" published in Lancet in 2022.
Disclaimer - StrokeFM is an Educational Podcast, by listening you understand that there is no duty of care, please read the full disclaimer.
StrokeFM is the Official Podcast of the CSC (Canadian Stroke Consortium), Founder and Executive Producer Dr. Houman Khosravani @neuroccm; Audio Engineer and Producer Dr. Jaime Cazes @JaimeCazes.
The music for this educational podcast is graciously provided by the musician breakmastercylinder @BrkmstrCylinder
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