For the first time in nearly 30 years, a promising new approach to treating stroke has been determined to be effective in in the largest clinical stroke study of its kind in Canada.
Co-led by researchers at Sunnybrook Health Sciences Centre and the University of Calgary at the Foothills Medical Centre, the study’s findings that Tenecteplase (TNK), a heart attack drug, is an effective treatment for acute ischemic stroke, could lead to a change in clinical practice.
The pivotal study has recently been published in The Lancet.
Researchers also presented the ground-breaking results at the Canadian Neurological Science Federation Conference in Montreal, and the 2022 European Stroke Organization Conference in France. The results have also been published in The Lancet.
Dr. Rick Swartz, study co-principal investigator and stroke neurologist at Sunnybrook, shares insight on how this latest breakthrough could become the standard treatment for acute ischemic stroke and what it means for patients.
What is the current treatment for acute ischemic strokes?
Dr. Swartz: Currently, Alteplase, or tPA, is the standard for treatment of acute ischemic stroke. It is a clot-busting drug that has been used to treat stroke for decades. tPA is extremely effective in treating stroke.
How can a heart attack drug also treat stroke?
Dr. Swartz: Tenecteplase, or TNK, is a common medication used to treat heart attacks and works to dissolve clots to help restore blood flow. TNK is a modified version of tPA. It binds to fibrin, which is part of a blood clot, and helps to dissolve the clot, restoring blood flow to the brain. It is important to note the brain is more complicated and vulnerable to bleeding than the heart, so the dosage in this study for stroke was half the dose that is typically given for treatment of heart attacks.
Why is Tenecteplase effective in the treatment of stroke?
Dr. Swartz: One of the reasons Tenecteplase, or TNK, is so effective is that in can be administered as a single dose directly to the patient. In contrast tPA requires an infusion over the course of an hour. The ability to give it as a one-time dose saves critical time and complication as TNK could potentially be administered wherever the patient is seen first, at a medical centre or small hospital.
What does this mean for patients?
Dr. Swartz: There are extensive implications for our study findings. This is the first time since 1995 that a new approach to emergency stroke medical treatment has been studied and found to be at least as effective and safe as the current treatment, tPA. In real-world use, it may lead to faster treatment, and could be especially helpful for people with large clots being treated and sent to centres like Sunnybrook for further interventions.
In stroke, every minute counts – the faster the treatment, the greater chance of brain recovery. Current stroke guidelines will need to be reviewed, but our findings could change the way stroke is treated in Canada and around the world.
