Tenecteplase is increasingly being seen by scientists as a better
choice as a clot-busting drug for stroke patients than alteplase. But
the use of clot-busting drugs in general for minor strokes and transient
ischemic attacks is controversial. Besides being wary about the side
effects, which can include intracranial bleeding, physicians often
underestimate the potential impact of such strokes.
“We found the risk to patients from bleeding is low. We have also done work that shows the risk of disability or death from minor strokes is actually higher than we used to think,” says Coutts, a member of HBI’s Stroke Neuroteam who is also an associate professor in the departments of clinical neurosciences and radiology at the Cumming School of Medicine, as well as a stroke neurologist with Alberta Health Services.
The safety and potential feasibility of tenecteplase was investigated across Canada as part of the two-year TEMPO-1 study (TNK-tPA Evaluation for Minor ischemic stroke with Proven Occlusion), says Coutts, who led the study. It was published online this month in the journal Stroke.
Study's next phase will test the drug's effectiveness
The drug’s actual effectiveness will be tested in the study’s next phase, TEMPO-2, as part of an international research effort. “We think the drug works more quickly and it has a lower risk of hemorrhage than alteplase,” says Coutts, adding it may particularly help patients who are elderly.
Most strokes are ischemic, which means they are caused by blood clots. They afflict about 700,000 North Americans per year, with up to 70 per cent of these diagnosed as minor. “In a severe or major stroke, for example, somebody might be completely unable to move one side of their body,” says Coutts. “In a minor stroke, there might be a little bit of weakness, a little bit of facial droop, that sort of thing.”
Often prescribed to fight major strokes, alteplase is also used for some minor ones. However, most of these minor strokes are often seen as being too mild to need clot-busting drugs of any kind.
Minor strokes can have a major impact on quality of life
Up to a third of such patients subsequently die or suffer significant loss of independence within 90 days of suffering a minor stroke, says Coutts, who is also a member of the Calgary Stroke Program. “Minor strokes can affect the ability to work and drive, so they really aren’t that minor,” she says. “They can affect people’s memory, or ability to move properly, or create difficulties with fatigue or speaking. They often have devastating consequences in older people because they are not as able to bounce back. They end up in long-term care because they can’t live at home.”
First used to unblock heart arteries, tenecteplase is now being used on clots that prevent the flow of blood in the brain. The study targeted minor stroke patients at the highest risk for disability — those who have clots that can be seen on a CT scan, says Coutts.
TEMPO-1 involved 50 such patients ranging from 36 to 98 years old, with a median age of 71. The study was carried out in Quebec City, Montreal, Sherbrooke, Ottawa, Vancouver and Victoria, although most of the patients were in Calgary.
Funding for the study was provided by the Heart and Stroke Foundation of Alberta and Nunavut, along with Alberta Innovates - Health Solutions.
Brain and Mental Health is one of six strategic research themes guiding the University of Calgary toward its Eyes High goals.
“We found the risk to patients from bleeding is low. We have also done work that shows the risk of disability or death from minor strokes is actually higher than we used to think,” says Coutts, a member of HBI’s Stroke Neuroteam who is also an associate professor in the departments of clinical neurosciences and radiology at the Cumming School of Medicine, as well as a stroke neurologist with Alberta Health Services.
The safety and potential feasibility of tenecteplase was investigated across Canada as part of the two-year TEMPO-1 study (TNK-tPA Evaluation for Minor ischemic stroke with Proven Occlusion), says Coutts, who led the study. It was published online this month in the journal Stroke.
Study's next phase will test the drug's effectiveness
The drug’s actual effectiveness will be tested in the study’s next phase, TEMPO-2, as part of an international research effort. “We think the drug works more quickly and it has a lower risk of hemorrhage than alteplase,” says Coutts, adding it may particularly help patients who are elderly.
Most strokes are ischemic, which means they are caused by blood clots. They afflict about 700,000 North Americans per year, with up to 70 per cent of these diagnosed as minor. “In a severe or major stroke, for example, somebody might be completely unable to move one side of their body,” says Coutts. “In a minor stroke, there might be a little bit of weakness, a little bit of facial droop, that sort of thing.”
Often prescribed to fight major strokes, alteplase is also used for some minor ones. However, most of these minor strokes are often seen as being too mild to need clot-busting drugs of any kind.
Minor strokes can have a major impact on quality of life
Up to a third of such patients subsequently die or suffer significant loss of independence within 90 days of suffering a minor stroke, says Coutts, who is also a member of the Calgary Stroke Program. “Minor strokes can affect the ability to work and drive, so they really aren’t that minor,” she says. “They can affect people’s memory, or ability to move properly, or create difficulties with fatigue or speaking. They often have devastating consequences in older people because they are not as able to bounce back. They end up in long-term care because they can’t live at home.”
First used to unblock heart arteries, tenecteplase is now being used on clots that prevent the flow of blood in the brain. The study targeted minor stroke patients at the highest risk for disability — those who have clots that can be seen on a CT scan, says Coutts.
TEMPO-1 involved 50 such patients ranging from 36 to 98 years old, with a median age of 71. The study was carried out in Quebec City, Montreal, Sherbrooke, Ottawa, Vancouver and Victoria, although most of the patients were in Calgary.
Funding for the study was provided by the Heart and Stroke Foundation of Alberta and Nunavut, along with Alberta Innovates - Health Solutions.
Brain and Mental Health is one of six strategic research themes guiding the University of Calgary toward its Eyes High goals.