A survival benefit with tenecteplase?

A survival benefit with tenecteplase?

Thrombolytic therapy during out-of-hospital cardiac arrest does not improve outcomes according to a new study. There has been considerable interest in thrombolytic therapy during cardiopulmonary resuscitation since it has been shown that 70% of these arrests are due to acute myocardial infarction or pulmonary embolism. European researchers randomized 1050 patients with witnessed out-of-hospital cardiac arrest to tenecteplase or placebo during cardiopulmonary resuscitation. The primary endpoint was 30-day survival and the secondary endpoints were hospital admission, return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and neurologic outcomes. The trial was discontinued early when it was found that there was no survival benefit with tenecteplase. Thirty-day survival was 14.7% with tenecteplase and 17% with placebo. Secondary outcomes similarly showed no benefit from tenecteplase. The authors conclude that when tenecteplase was used during advanced life support for out-of-hospital cardiac arrest there was no improvement in outcomes in comparison to placebo (Bottiger BW, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 2008;359:2651-2662).