Question and Methods: This multicentre, open label, randomized control trial at 22 primary and comprehensive stroke centres across Canada aimed to see if IV-TNK given as a 0.25mg/kg bolus was both as effective and safe as IV t-PA.
Findings: This trial enrolled 1600 patients and demonstrates that TNK is non-inferior to tPA in terms of excellent neurologic outcome (mRS 0-1) at 90-120 days and safety profile meeting their pre-specified non-inferiority threshold.
Limitations: Limitations to this study include its open label design.
Interpretation: This is a practice changing paper. The results of this trial and the practical advantages of a single bolus regimen with TNK will likely change the tide of standard of care for thrombolysis of acute ischemic stroke.
JC Supervisor: Dr. Ian Stiell
Dr. Ferguson is an Emergency Medicine resident at the University of Ottawa, Department of Emergency Medicine.
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
MD, MSc, FRCPC