Project Lead

Associate Professor Andrew Bivard

Full Bio

Lead partner

The University of Melbourne


Austin Health; Royal Melbourne Hospital; St Vincent’s Hospital Melbourne; Western Health

Project summary

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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.

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. If tenecteplase results in better clinical outcomes in addition to these practical advantages, there is significant scope for improved patient outcomes and cost savings.

Expansion activities 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 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