Background

Tenecteplase (TNK) is gaining recognition as a novel therapy for acute ischemic stroke (AIS). Despite TNK offering a longer half-life, time and cost saving benefits and comparable treatment and safety profiles to Alteplase (ALT), the adoption of TNK as a treatment for AIS presents challenges for hospital systems.

Objective

Identify barriers and facilitators of TNK implementation at acute care hospitals in Texas.

Methods

This prospective survey used open-ended questions and Likert statements generated from content experts and informed by qualitative research. Stroke clinicians and nurses working at 40 different hospitals in Texas were surveyed using a virtual platform.

Results

The 40 hospitals had a median of 34 (IQR 24.5–49) emergency department beds and 42.5 (IQR 23.5–64.5) inpatient stroke beds with 506.5 (IQR 350–797.5) annual stroke admissions. Fifty percent of the hospitals were Comprehensive Stroke Centers, and 18 (45 %) were solely using ALT for treatment of eligible AIS patients. Primary facilitators to TNK transition were team buy-in and a willingness of stroke physicians, nurses, and pharmacists to adopt TNK. Leading barriers were lack of clinical evidence supporting TNK safety profile inadequate evidence supporting TNK use and a lack of American Heart Association guidelines support for TNK administration in all AIS cases.

Conclusion

Understanding common barriers and facilitators to TNK adoption can assist acute care hospitals deciding to implement TNK as a treatment for AIS. These findings will be used to design a TNK adoption Toolkit, utilizing implementation science techniques, to address identified obstacles and to leverage facilitators.

中文翻译：

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替奈普酶转换因子的多中心探索：定量分析

背景

替奈普酶(TNK) 作为一种治疗急性缺血性中风 (AIS) 的新型疗法正在获得认可。尽管 TNK 具有与阿替普酶 (ALT) 更长的半衰期、节省时间和成本的优势以及可比的治疗和安全性，但采用 TNK 作为 AIS 的治疗方法给医院系统带来了挑战。

客观的

确定德克萨斯州急症护理医院实施 TNK 的障碍和促进因素。

方法

这项前瞻性调查使用了内容专家提出的开放式问题和李克特陈述，并通过定性研究提供信息。使用虚拟平台对德克萨斯州 40 家不同医院的中风临床医生和护士进行了调查。

结果

这 40 家医院平均拥有 34 张 (IQR 24.5–49) 急诊科床位和 42.5 张 (IQR 23.5–64.5) 住院卒中床位，每年卒中入院人数为 506.5 (IQR 350–797.5)。 50% 的医院是综合性卒中中心，其中 18 家 (45%) 医院仅使用 ALT 治疗符合条件的 AIS 患者。 TNK 过渡的主要促进因素是团队的支持以及中风医生、护士和药剂师采用 TNK 的意愿。主要障碍是缺乏支持 TNK 安全性的临床证据，支持 TNK 使用的证据不足，以及缺乏美国心脏协会指南支持在所有 AIS 病例中使用 TNK。

结论

了解采用 TNK 的常见障碍和促进因素可以帮助急症护理医院决定采用 TNK 作为 AIS 的治疗方法。这些发现将用于设计 TNK 采用工具包，利用实施科学技术来解决已识别的障碍并利用促进者。