Dr. Glaucomflecken Explains: Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours
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- Опубліковано 27 вер 2024
- You don’t know?? Bask in the moment of knowing more about recent NEJM research than your colleagues.
The latest video in our partnership with @DGlaucomflecken looks at research into tenecteplase for ischemic stroke at 4.5 to 24 hours. Use the following link for free access to the article: nej.md/4ef0xYG
#Neurology #Stroke #MedicalEducation #MedEd #NEJM
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Just want to give a big thank you to NEJM and Dr G for this whole project. It makes up to date research more accessible and increases awareness of interesting studies. As a layperson, I feel more in touch with medical research, so I can only imagine the clinical benefits this series must be providing for those who will benefit from the awareness
This sounds like a game changer for rural medicine
Texaco Mike whips up the best Tenecteplase.
@@lindiatle- as long as you don't mind the smell! 😆
@lindiatle- Do you think he makes it in his instapot or does he use his green egg smoker?
Texaco Mike could probably turn his hand to thrombectomy. Hard part is getting the locals to present within a week. You can still drive a tractor with one arm and leg.
My mom was within the 4.5 hour window and got it. Every doctor I spoke with was shocked, since it’s given so infrequently.
Her doctor said she probably wouldn’t have survived without it. She still has hemiplegia, but is getting stronger. And she’s here! I can talk with her, and take the grandchildren to visit her (she lives on the other side of the country).
Hopefully now that it’s shown to be beneficial more people can access this lifesaving and disability sparing treatment.
In summary Tenecteplase better than Aspirin.... Got it.....
I’m so happy to hear she’s doing well! As a prehospital provider, we break our backs (and the ambulance’s transmission) to get patients to therapy on time and red tape has robbed length and quality of life from so many.
Two in particular haunt me. A young lady who began to have slurred speech while talking on the phone with her son an hour before arrival, but was refused tenecteplase because she hadn’t been seen in person since the morning before. The second was an older gal with a similar timeframe, but her neurologist at an academic center demanded she be transported 45 minutes to his facility for thrombectomy. She was talking and in good spirits when we left, but by the time we got to the hospital she could only look at me in terror because she could no longer form speech. We were supposed to take her straight to the OR, but there was another thirty minute delay for registration before the neurologist would touch her.
All this to say that hopefully we can be a little less uptight about thrombolytics. I would personally choose life threatening bleeding over ischemic stroke any day of the week, and twice on Sundays.
@@ebubechiibegbula5968This got me thinking, is Tenecteplase too dangerous to use in place of Aspirin for a layman suspecting a stroke? How about EMT? Is confirmation that the stroke is caused by large vessel blockage more safe than confirming later?
@@AkaiAzul If it's a hemorragic stroke and you give tenecteplase its the same as shooting the person in the head, and even doctors can't safely diferentiate isquemic from hemorragic stroke without a CT scan. So yeah, extremely dangerous.
You should win an award for costume design. Nobody would confuse the different bros.
This might be a practice changing article, thanks Dr. G, I'll look it up
I’m loving this collaboration with Dr G! 😂
This is a wonderful research with easily-comprehensible delivery thank y'all
This was a fantastic collaboration, and I'm really enjoying seeing these pop up on my youtube feed.
um...Neurology reads every article, always.
😂
Neurology is still speaking Nobel tongue
Another gem! (And I really have to stop drinking coffee while I watch these. I don't think my key board can take much more splatter.)
As a previous stroke medical registrar, having an increased percentage of better outcome does not mean that the risk of a catastrophic complication from Thrombolysis is lower. The 4.5 hour threshold is an expert opinion of a balanced risk to benefit. Thrombolysis treatment has small benefits after 4.5 hours but the risk of bleed goes way up. The devil is in the details of percentages of risk. Look up stroke visual decision aids.
it looks like the rate of hemorrhage was only 3% vs. 0.8%, with such a low rate, I don't know if I would consider that clinically significant, but I guess that would be a judgement call
You would expect the complications to show up in the functional outcome. If thrombolysis causes a brain bleed, but that doesn't result in more disability or mortality, the brain bleed isn't really a complication, just a cosmetic issue.
Wowww that really does sound interesting!!! And of course the banter comedic parts are always funny!!!! 😆
Amazing
I gained knowledge and I have a smile on my face.
Thank you!
Can i claim watching this as cme credit ?😅😅😅
Having "Tenecteplase please" inscribed on my medical bracelet....
I wonder if that could have saved my grandfather from hemiplegia.
Grandpa passed from a stroke around this time last year. He did get the medicine in time and they airlifted him to another hospital for surgery. The scans the next morning showed too much damage. He was 91 and was ready to go home to Jesus. He made his wishes known, so we knew the right thing was to let him go.
Censor! Touched a nerve did I? Bloody Good!
1st Lol
2nd will be considered
😂😂😂😂😂😂
The Emergency Physician needs to be admitted to the burn unit
🤣🤣
I was just thinking the same thing.
Very interesting. Going to have a look at the paper. The 4.5 hour window is often very tight and this is potentially game changing. At my hospital though the stroke calls come direct to the stroke team bypassing the cycle helmets!
If I had one CME for each time I've watched ER having this moment, I would have completed this year's requirement.
One of my favorite things to do so far in pharmacy residency has been mixing and giving teneteplase. When the neurologist gives you the go ahead and you go flush, tnk, flush. It’s just empowering.
I didn’t know you could read 🤣🤣
"Yeah, go ahead, just watch a UA-cam video first"... Hilarious throwaway!
The sheer surprise of "I didn't know you could read". Savage.
In fairness to neurology, they saw the journal article's name had the word "medicine" in it and assumed it would be a 5 hr discussion of hyponatremia during rounds.
That final line killed me. I wont spoil it for people, but I am dead from laughing now.
This NEJM thingy seems to be a serious outfit
These med journal videos are fast becoming my favorite!
I know what a stroke is, but that's about it. Still amusing though
Can this be how I receive all my journal updates. Pleeeeaaaasssse
What about TIMELESS though???
That last line was great
NEJM, now only this mode of teaching could be widening, I would to be more attentive 😂.👍🏼
What if the Cardiologist and Neurologist had an argument over this too? Or another scenario?
Savagely brilliant, loving this series! 😆
Just got to remember to request tenecteplase if I have a stroke in the boonies now... 🤔
Or "Brain anti-clot juice, bro" as Ortho would say!
That is an awesome vid, it's like that in every specialty, not just medicine.
It’s awesome that you have been collaborating with NEJM for these videos. 😊
that last exchange!!!!! LMFAOOOOOOOOOO. but also great news for stroke patients.
Dr Glaukenflacken. Not to be that guy but you don’t mention how that outside window tenecteplase also increases the intracranial bleeding risk significantly which is also mentioned for the paper. Kind of an important detail cuz everyone is going to get the false impression they should be giving TNK at all rural hospitals now
Thank you for communicating important new NEJM information through your highly effective method. It would be appreciated if you made more of this same type of content. The Lancet, too?
Damn! That was quite the burn from Neuro to ER!! 🤣😂🤣😂🤣😂
My facility recently changed from alteplase to tenectaplase for AIS and from a work flow standpoint we saw massive reductions in door-to-needle time as we can store the tenectaplase in the ED. We did not have mechanical thrombectamy capability there.
As an aspiring academic, I wish this level of coverage was standard practice. (Un)fortunately, medicine isn't my field, so I forsee no means to wver have a paper to submit for Dr. G to use for script inspiration.
Loving the new initiative to use skits to cover recent major trial findings to prompt further review, and in turn promote ongoing evidence based clinical practice so as to optimise patient care outcomes.
I'm curious to know how ER neurology dresses. Is it bike outfit with a tie or maybe the normal outfit with a bike helmet, a bike outfit that's printed like his normal outfit.
I love how neurology knew, but just wanted to see if Emergency could fully recall the article 😂
It's constantly amazing how different all the characters are.
No surprise the neurologist didnt know about it, he probably prefers his patients not to bleed post treatment
I didn't understand any of that. Great video as always! I feel like an idiot.
This is the template from which all medical research should be shared.
I don't understand the tendency toward such conservative treatment when the known consequences are so catastrophic.
Conversion from an ischemic stroke that you will probably survive with possible deficits, to a hemorrhagic stroke that will probably kill you.
That’s the concern.
Informative AND entertaining!!
Best journal club ever.
lol damn neuro had to get his shot in
Funny, thanks.
What’s the difference between Tenecteplase and TPA?
Tenectaplase is TPA. TPA has become an unfortunate shorthand for the medication Alteplase.
TPA stands for Tissue Plasminogen Activator. Both Tenectaplase and Alteplase are Tissue Plasminogen Acttivators.
The only real difference is that Tenectaplase doesn’t have a label indication for ischemic stroke, and is is a weight based IV push vs. the calculation for push and drip needed for Alteplase.
Penumbra
Love the Phi Beta Kappa tie
😅
Saw the recording reflection in your goggles
1st
Thrombolytics (clot dissolving drugs), used to restore blood flow to dying brain tissue, can cause disastrous intracranial bleeding if given too long after stroke symptom onset. A recent study suggests that tenecteplase, a newer thrombolytic, may be safer.
I still don’t understand why TNK is still considered off label use for strokes.