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Alternative Stroke Treatment Proposed to Protect Emergency Health Care Workers Against COVID-19

AUSTIN, Texas — Researchers are proposing the use of an alternative treatment for acute ischemic stroke to reduce health care workers’ exposure to COVID-19 in hospital emergency departments, according to an editorial published in the latest edition of JAMA Neurology.

Specifically, the researchers are suggesting replacing the commonly used stroke drug alteplase with a similar but less frequently used treatment called tenecteplase. Alteplase and tenecteplase both fall in the category of clot-busting drugs known as tissue plasminogen activators, or tPA.

“Treating patients suffering from acute stroke in the emergency department during the pandemic is an especially vulnerable situation for clinicians, because stroke victims can’t always provide their own history to screen for COVID-19 and the urgency of assessing and treating stroke requires action before the results of COVID testing are known,” said co-author Steven Warach, M.D., professor of neurology at Dell Medical School at The University of Texas at Austin.

Before the COVID-19 pandemic, some stroke centers across the country had switched from alteplase to tenecteplase for treatment of stroke, because it is quicker and simpler to use, costs less, and randomized clinical trials compared to alteplase showed it is at least as effective in limiting disability caused by stroke and may even be better in opening the blocked arteries causing the stroke, according to the editorial. Tenecteplase is given as a single, five-second injection that requires about two minutes to mix, prepare and administer. In contrast, the conventional alteplase treatment takes about an hour to deliver.

Warach co-wrote the editorial with Jeffrey Saver, M.D., a neurology professor at the David Geffen School of Medicine at UCLA. The pair contend that the simpler tenecteplase treatment may have additional advantages during the pandemic, because it cuts the amount of time health care workers spend near potentially infected patients. Additionally, unlike alteplase, it does not require an intravenous infusion pump that follows the patient through other hospital departments and wards, possibly providing more surfaces for the virus and staff to touch.

Because alteplase is effective at reducing blood clots, it is being used to treat severe lung complications in COVID-19 patients. Some regions have experienced shortages of alteplase because of this increased demand, according to Warach.

“Tenecteplase treatment of acute stroke may be an efficient adaption to some of the challenges of the COVID-19 pandemic – reducing the exposure to health care workers to the virus and addressing shortages of alteplase supplies that might arise, especially in regions that are experiencing prolonged surges in COVID-19 hospital admissions,” said Warach.