Alternative clot busting drug improves outcomes for stroke patients

Associate Professor Henry Ma

An alternative and more cost-effective clot-busting drug has greater benefits for stroke patients than the current standard treatment, according to latest research including Monash University collaborators.

Published in the New England Journal of Medicine, the results of a clinical trial reveal Tenecteplase—a drug that dissolves unwanted blood clots—leads to better outcomes for ischaemic stroke patients than the current therapy, Alteplase, prior to surgical removal of a clot.

Stroke is a leading cause of death and disability worldwide.  Most strokes (around 80 per cent) are ischaemic, resulting from a blocked artery causing reduced blood flow to regions of the brain.

“Treatments to restore blood flow, including drugs such as Tenecteplase and Alteplase, reduce disability for stroke survivors,” said study co-author Associate Professor Henry Ma from Monash University’s Stroke and Ageing Research Group.

“This is the first study that shows patients given Tenecteplase before endovascular clot retrieval had higher rates of blood flow and better functional outcome when treated within 4.5 hours of stroke onset,” said Associate Professor Ma, who is also Director of Neurology Department at Monash Health.

“Another benefit of Tenecteplase is that it’s administered intravenously in a single dose over a short period of time and relatively cheaper than Alteplase.”

“Alteplase, the current standard treatment, is given as an infusion over one hour and results in lower rates of blood flow for large blood clots.”

One of the most important findings is that for every 9 patients being treated with Tenecteplase, one less patient will require surgical clot removal due to the breakdown of the clot and re-establishment of blood flow to the brain,” Associate Professor Ma said.

“This will not just save precious healthcare resources but also improve outcomes.”

“Patients from rural and regional centres who need to travel long distances to clot retrieval centres such as Monash Medical Centre will benefit greatly from early clot breakdown as every second counts.”

A total of 202 patients were enrolled in the randomised trial in 13 hospitals across Australia and New Zealand between 2015 and 2017.

“Study participants were stroke patients with large clots who were eligible for intravenous clot busting and surgical clot removal within 4.5 hours of stroke onset,” said Monash Health neurologist and co-author Professor Thanh Phan, also from Monash University’s Stroke and Ageing Research Group.

“Surgical clot removal, known as endovascular clot retrieval (ECR), is a relatively new procedure where a large clot is removed by passing a catheter via the large artery in the groin.”

“ECR results in marked improvements in patient outcomes—in a 2015 landmark study published in the New England Journal of Medicine, up to 70 per cent of patients recovered,” Professor Phan said.

Monash Medical Centre is one of only two dedicated ECR centres in Victoria, providing 24-hour, seven-day service for stroke patients across the state.