News:Tenecteplase Did Not Improve Outcomes Compared to Placebo During CPR for Out-of-Hospital Cardiac Arrest

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Thrombolysis with tenecteplase did not improve survival in patients receiving cardiopulmonary resuscitation (CPR) when compared to placebo, according to a study published in the New England Journal of Medicine. Between 2004 to early 2006, 1050 adults with a witnessed cardiac arrest outside of the hospital were prospectively randomized to either intravenous tenecteplase or placebo during the administration of CPR without the additional use of antiplatelets or antithrombins. The difference in rates of 30-day survival (14.7% tenecteplase vs. 17.0% placebo, p=0.36), 24 hour survival (30.6% vs. 33.3%, p=0.39), hospital admission (53.5% vs. 55.0%, p=0.67), or neurological outcome (p=0.69) was not statistically significant between the two groups. The inefficacy of the tenecteplase treatment lead to the trial's early termination. The authors suggest that their results may have differed from previous smaller studies because this trial did not use adjunctive heparin and aspirin and had a shorter collapse-to-drug administration time. Furthermore, CPR may not have provided enough sustained perfusion pressure to enable the tenecteplase to travel to clots in the coronaries. Noted limitations of the study include: an inability to determine the causes of underlying disease for all patients; the underlying variable nature of the prehospital setting; and differences in post-CPR care between the different European centers involved. (NEJM by Bernd W Bottiger et al.)