Abstract WP179: Differences in door-to-needle times with centralized preparation of alteplase and tenecteplase for acute ischemic stroke

Purpose: Conflicting information exists regarding the clinical and operational impact of transitioning from alteplase to tenecteplase for treatment of acute ischemic stroke (AIS). Furthermore, most studies focus on door-to-needle (DTN) time, and limited information investigates the effect on pharmacy-specific metrics. This study assessed the potential impact of the transition from alteplase to tenecteplase for the management of AIS on DTN time, order verification, preparation, and delivery times when prepared in a centralized pharmacy. Methods: In this single-center, retrospective, observational cohort study, we analyzed a local registry of patients treated for AIS at a Primary Stroke Center. Patients treated with alteplase from December 1, 2020, to November 30, 2022, were compared to patients treated with tenecteplase from December 1, 2022, to November 30, 2024, following an institution-wide formulary switch for AIS. The primary outcome was DTN time. Secondary outcomes included order-to-verification time, verification-to-preparation time, preparation-to-hang time, and order-to-hang time. Safety outcomes included incidence of bleeding and all-cause mortality. Results: A total of 171 patients were treated in the alteplase (n=97) and tenecteplase (n=74) groups. Median (IQR) DTN time was 59 (46-75) minutes in the alteplase group and 52 (42-74) minutes in the tenecteplase group [p=0.259]. No differences were found between alteplase and tenecteplase groups in order-to-verification (2 vs. 2 min; p=0.525), order-to-preparation (7 vs. 7 min; p=0.212), or order-to-administration times (12 vs. 12 min; p=0.687). Conclusion: When dispensed from a centralized pharmacy, formulary transition from alteplase to tenecteplase for AIS was not associated with significant differences in DTN times or pharmacy-specific metrics. Centralized dispensing remains a viable strategy for efficient treatment of ischemic stroke. Further studies are needed to assess the impact of the transition from centralized dispensing to bedside preparation.