A Time and “-plase” for Everything: Updated Management of Acute Ischemic Stroke

Alteplase and tenecteplase are commonly utilized within health-systems requiring rapid decision-making by the healthcare team. These medications include high risk of life-threatening side effects for which patients must be carefully chosen. Pharmacists must be consistently ready to review orders for appropriateness. Recent literature search revealed updates in the timing and dosing scheme related to the use of alteplase for acute ischemic stroke. 2019 Stroke guidelines added a new section on tenecteplase, highly likely to be a new concept among many pharmacists practicing outside of neurology. Endovascular thrombectomy for acute ischemic stroke is a growing topic in neurology and Pharmacists should have a basic understanding of the process and timing of this procedure to understand how to select pharmacotherapy. This activity will be a knowledge-based activity outlining key principles related to the mechanism of action of fibrinolytic therapy (alteplase, tenecteplase) so the audience understands the background of the disease state and our pharmacotherapy goals. A thorough literature review will be provided to understand the efficacy and timing of these agents. A focus on tenecteplase will be provided as this may be very new to many pharmacists since the literature is only about 5 years old. Endovascular procedures will be discussed so pharmacists can visualize the process of selecting patients and the outcomes associated with this therapy. Multiple choice questions will be asked throughout to engage the audience and assess understanding.