Methodology: 4.5/5
Usefulness: 5/5

Menon BK, et al. Lancet. 2022 Jul 16;400(10347):161-169. doi: 10.1016/S0140-6736(22)01054-6.

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. 

By: Dr. Emma Ferguson

JC Supervisor: Dr. Ian Stiell

Associated Blog Posts of interest:
Managing Complications of Acute Stroke Therapy
Thrombolytic Therapy: A Stroke of Luck?