ISC.15: TNK tPA as alternative to alteplase appears safe, feasible

Even a minor stroke can lead to disability if paired with an intracranial occlusion. Researchers explored the use of tenecteplase (TNK) tissue-type plasminogen activator (tPA) to safely treat this type of stroke before it progressed.

The research presented Feb. 12 during the American Stroke Association’s 2015 International Stroke Conference (ISC) in Nashville, Tenn., used TNK as opposed to alteplase. TNK is a mutant tPA with a longer half-life and higher fibrin specificity. Reports suggest TNK may be easier to administer and may have lower risks for intracranial bleeding.

Four medical centers participated in patient selection for the TEMPO-1 (TNK–Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke With Proven Occlusion) study. TEMPO-1, led by Shelagh B. Coutts, MD, MSc, from the Calgary Stroke Program at the University of Calgary in Alberta, Canada, enrolled 50 patients presenting with minor ischemic stroke and occlusions verified by CT angiography. Patients were then randomized between a 0.1 or 0.25 mg per kg dose of TNK, called tier one and tier two, respectively.

No serious drug-related adverse events were reported for patients given the lower dose. One patient in the higher dose group had a small, transient, symptomatic intracranial hemorrhage. At 90 days, however, the patient had an independent outcome (modified Rankin Score of 2). A total of 90 percent of patients had independent outcomes at 90 days; 66 percent had excellent functional outcomes (modified Rankin score of 0-1).

Among tier one patients, 39 percent had complete recanalization and 17 percent had partial recanalization. Complete recanalization was more frequent among tier two patients (52 percent) and fewer had partial recanalization (9 percent). Coutts et al noted that complete recanalization led to significantly more patients with excellent functional outcomes at 90 days.

Based on these findings, Coutts and the TEMPO-1 study group determined that using TNK tPA was safe and feasible, as was recanalization of patients with minor stroke with occlusions, pending confirmation from a larger, randomized control trial.

The study was simultaneously published online Feb. 12 in Stroke.