New stroke drug melts brain clots faster, costs less and improves recovery

A breakthrough in stroke medical research found a drug, traditionally used for heart attacks, dissolves blood clots in the brain faster and more effectively than standard stroke drugs.

The EXTEND-IA TNK randomised clinical trial, led by The Royal Melbourne Hospital (RMH) and the University of Melbourne, compared the effectiveness of two drugs, Tenecteplase and Alteplase, in dissolving stroke-causing blood clots in the brain, before patients went on to have clot retrieval surgery.

RMH neurologist, Head of Stroke and study co-principal investigator Bruce Campbell said the study, published in the New England Journal of Medicine, found the drug Tenecteplase was life changing in treatment of ischemic stroke.

“Our study showed that the use of Tenecteplase restored blood flow to the brain before clot retrieval surgery in double the number of patients compared to Alteplase (22 per cent compared with 10 per cent of patients),” Associate Professor Campbell said.

“For one in five patients treated with Tenecteplase, clot retrieval surgery was not required and the earlier restoration of blood flow was associated with improved functional recovery in Tenecteplase-treated patients.

“Tenecteplase can be given over 10 seconds compared to the one-hour infusion of Alteplase, which has practical advantages when transferring patients between hospitals for clot retrieval surgery and is also less expensive,” Associate Professor Campbell said.

EXTEND-IA TNK involved 202 participants, across 13 hospitals in Australia and New Zealand, who either received Tenecteplase or Alteplase.

Peter Mitchell, Director Neurointervention Service and study co-principal investigator at the RMH, said the study results were likely to change stroke treatment guidelines and clinical practice.

“In treating stroke, it is critically important to restore blood flow to the brain as soon as possible,” said Professor Mitchell, head of the Statewide Endovascular Clot Retrieval Service at the RMH.

“This is achieved most effectively with clot retrieval surgery, but when the surgery is delayed for patients transferred from hospital to hospital, Tenecteplase is more likely to help restore blood flow than Alteplase.

“Tenecteplase is now likely to become the preferred medication for clot dissolving in stroke patients who need clot retrieval surgery,” Professor Mitchell said.

The EXTEND-IA TNK study was supported by grants from the National Health and Medical Research Council of Australia, the Australasian College of Physicians, The Royal Melbourne Hospital Foundation, the National Heart Foundation of Australia and the Stroke Foundation of Australia. Trial infrastructure was supported by an unrestricted grant from Medtronic who had no role in study design, conduct or analysis.

(Source: University of Melbourne, New England Journal of Medicine)