The University of Melbourne
Austin Health; Royal Melbourne Hospital; St Vincent’s Hospital Melbourne; Western Health
Ischemic stroke is a major public health problem, for which effective and accessible drug therapies remain limited. Current management of acute ischemic stroke includes treatment with recombinant tissue plasminogen activator (rtPA, or alteplase) to dissolve clot in a cerebral artery. The treatment effect of alteplase is much greater if given within 90 minutes of stroke onset. As a result, there has been a significant push to take stroke care to the patient in the form of the Mobile Stroke Unit (MSU).
The MSU is the first designed as a CT-capable ambulance that allows assessment and treatment of stroke patients in the pre-hospital setting. In the proposed research project, we will undertake a clinical trial investigating the effectiveness of a new thrombolytic agent in the MSU, tenecteplase. Tenecteplase has been shown to be significantly more effective at improving stroke survivor’s recovery and opening blocked blood vessels than alteplase in the hospital setting. However, it is unknown if earlier administration of tenecteplase is more effective than early administration of alteplase.
Expansion activities funded through the MRFF RART 2.2 Scheme include an increase to the number of community sites and diversification of patients groups, providing an increased generalisability and precision of results.
This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.
The tested agent, tenecteplase, is cheaper, easier to administer (no time-consuming infusions required) and more practical for an ambulance delivered therapy than the current standard of care alteplase.
Treatment with tenecteplase on the MSU in Melbourne resulted in a superior rate of early reperfusion compared with alteplase, and no safety concerns were noted. This trial provides evidence to support the use of tenecteplase and MSUs in an optimal model of stroke care.
The outcomes of this project will improve patient outcomes and provide validation of a new standard of care. Health economic findings showing improved efficiencies with the study intervention which included shorter hospital stay. The study will likely change practice for the mobile stroke unit.
- Australian Health Research Alliance (2021), On the Road to Smarter Stroke Care, https://ahra.org.au/2021/10/18/on-the-road-to-smarter-stroke-care/
- Bivard A, Zhao H, Churilov L, et al. Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial. The Lancet Neurology. 2022;21(6):520. DOI:https://doi.org/10.1016/S1474-4422(22)00171-5
This project is an initiative of the Australian Stroke Alliance, bringing together 37 organisations committed to improving urgent prehospital stroke care across the nation. To find out more, visit www.austrokealliance.org.au