"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Review article
peer-reviewed

Tenecteplase versus Alteplase for the Management of Acute Ischemic Stroke in a Low-income Country–Nepal: Cost, Efficacy, and Safety



Abstract

Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered, mutant tissue plasminogen activator, is an alternative thrombolytic agent. The economic feasibility of stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line, stroke patients cannot meet treatment expenses. Tenecteplase is easily available (for the management of acute coronary syndrome) in tertiary-level hospitals of Nepal and the price quote of tenecteplase ($450) is half the price of alteplase ($1000). In emergency cases, sometimes, the cost of alteplase can be greater than the patient can afford and they can't undergo thrombolysis even after arriving on time. However, evidence exists that supports the use of other alternatives (tenecteplase), which are also effective in the management of acute ischemic stroke. In this article, we examined current evidence for the efficacy and safety of tenecteplase when compared to alteplase. This review will make neurologists in Nepal familiar with the efficacy and safety of tenecteplase in comparison with alteplase since it is common for patients to not be able to afford the expensive alteplase, which makes guideline-based practice impossible some times.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Review article
peer-reviewed

Tenecteplase versus Alteplase for the Management of Acute Ischemic Stroke in a Low-income Country–Nepal: Cost, Efficacy, and Safety


Author Information

Gaurav Nepal Corresponding Author

Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine

Ghanshyam Kharel

Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine

Shaik Tanveer Ahamad

Department of Medicine, Deccan College of Medical Sciences

Babin Basnet

Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine


Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Review article
peer-reviewed

Tenecteplase versus Alteplase for the Management of Acute Ischemic Stroke in a Low-income Country–Nepal: Cost, Efficacy, and Safety


Figures etc.

Share
Review article
peer-reviewed

Tenecteplase versus Alteplase for the Management of Acute Ischemic Stroke in a Low-income Country–Nepal: Cost, Efficacy, and Safety

  • Author Information
    Gaurav Nepal Corresponding Author

    Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine

    Ghanshyam Kharel

    Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine

    Shaik Tanveer Ahamad

    Department of Medicine, Deccan College of Medical Sciences

    Babin Basnet

    Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: February 09, 2018

    DOI

    10.7759/cureus.2178

    Cite this article as:

    Nepal G, Kharel G, Ahamad S, et al. (February 09, 2018) Tenecteplase versus Alteplase for the Management of Acute Ischemic Stroke in a Low-income Country–Nepal: Cost, Efficacy, and Safety. Cureus 10(2): e2178. doi:10.7759/cureus.2178

    Publication history

    Received by Cureus: January 31, 2018
    Peer review began: February 05, 2018
    Peer review concluded: February 07, 2018
    Published: February 09, 2018

    Copyright

    © Copyright 2018
    Nepal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered, mutant tissue plasminogen activator, is an alternative thrombolytic agent. The economic feasibility of stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line, stroke patients cannot meet treatment expenses. Tenecteplase is easily available (for the management of acute coronary syndrome) in tertiary-level hospitals of Nepal and the price quote of tenecteplase ($450) is half the price of alteplase ($1000). In emergency cases, sometimes, the cost of alteplase can be greater than the patient can afford and they can't undergo thrombolysis even after arriving on time. However, evidence exists that supports the use of other alternatives (tenecteplase), which are also effective in the management of acute ischemic stroke. In this article, we examined current evidence for the efficacy and safety of tenecteplase when compared to alteplase. This review will make neurologists in Nepal familiar with the efficacy and safety of tenecteplase in comparison with alteplase since it is common for patients to not be able to afford the expensive alteplase, which makes guideline-based practice impossible some times.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.