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Cerebrovascular Disease

Stroke Thrombolysis With Tenecteplase to Reduce Emergency Department Spread of Coronavirus Disease 2019 and Shortages of Alteplase

Educational Objective
To understand how to limit the risks of the spread of COVID-19 during an acute stroke emergency

1 Credit CME

JAMA Neurology

Published Online: July 20, 2020

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Article Information and Disclosures

Steven J. Warach, MD, PhD^1,2;

Jeffrey L. Saver, MD³

Author Affiliations

¹Department of Neurology, Dell Medical School, University of Texas at Austin, Austin
²Ascension Texas, Austin
³Department of Neurology, Geffen School of Medicine at UCLA, Los Angeles, California

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Measures to reduce emergency department staff exposure to the severe acute respiratory syndrome coronavirus 2 have focused on screening and use of personal protective equipment. Reducing the time and intensity of interactions with individuals with known or suspected cases of coronavirus disease 2019 (COVID-19) is also desirable, insofar as such reductions do not compromise the quality or outcomes of care. The situation of an acute stroke emergency is a particularly vulnerable situation for exposure and transmission, since a substantial proportion of patients are unable to provide a history to screen them out for COVID-19.

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Article Information

Corresponding Author: Steven J. Warach, MD, PhD, Department of Neurology, Dell Medical School, University of Texas at Austin, 1601 Trinity St, Room 10.542, Austin, TX 78712 (steven.warach@austin.utexas.edu).

Published Online: July 20, 2020. doi:10.1001/jamaneurol.2020.2396

Conflict of Interest Disclosures: Dr Warach chairs the independent Data Monitoring Committee for the Phase III, Prospective, Double-blind, Randomized, Placebo-controlled Trial of Thrombolysis in Imaging-Eligible, Late-Window Patients to Assess the Efficacy and Safety of Tenecteplase (TIMELESS) clinical trial of tenecteplase for acute ischemic stroke, for which he receives financial compensation from Genentech. Dr Saver reported grants and personal fees from Boehringer Ingelheim outside the submitted work.

References

Keyt BA , Paoni NF , Refino CJ , et al. A faster-acting and more potent form of tissue plasminogen activator. Proc Natl Acad Sci U S A. 1994;91(9):3670-3674. doi:10.1073/pnas.91.9.3670 PubMed Google Scholar Crossref

Kheiri B , Osman M , Abdalla A , et al. Tenecteplase versus alteplase for management of acute ischemic stroke: a pairwise and network meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2018;46(4):440-450. doi:10.1007/s11239-018-1721-3 PubMed Google Scholar Crossref

Burgos AM , Saver JL . Evidence that tenecteplase is noninferior to alteplase for acute ischemic stroke: meta-analysis of 5 randomized trials. Stroke. 2019;50(8):2156-2162. doi:10.1161/STROKEAHA.119.025080 PubMed Google Scholar Crossref

Wang J , Hajizadeh N , Moore EE , et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost. Published online April 8, 2020. doi:10.1111/jth.14828 PubMed Google Scholar

Powers WJ , Rabinstein AA , Ackerson T , et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.