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.
JC Supervisor: Dr. Ian Stiell
Associated Blog Posts of interest:
Managing Complications of Acute Stroke Therapy
Thrombolytic Therapy: A Stroke of Luck?