Objective:
To report the first known case of intraosseous (IO) administration of tenecteplase in stroke.
Background:
Tenecteplase, while currently used off-label, is quickly becoming favored over alteplase in treatment of acute ischemic stroke due to its increased fibrin specificity, longer half-life, and administration in bolus versus infusion form. When timely IV access cannot be established, previous case reports have shown use of IO route for treatment with alteplase. However, there has been no prior case to our knowledge that demonstrates the safe and effective use of IO tenecteplase in stroke.
Results:
A 51-year-old female, who was hospitalized for gluteal abscess and necrotizing fasciitis requiring multiple wound debridements, developed sudden onset aphasia in the setting of acute atrial fibrillation. The patient was eligible for systemic thrombolysis. However, IV access could not be obtained despite repeated attempts. Given the urgent need for therapeutic intervention, IO access was pursued and tenecteplase was administered without complications. MRI of her brain demonstrated ischemia near Wernicke’s area. Two days following stroke onset, the patient experienced near-resolution of symptoms.
Conclusions:
In the emergent treatment of acute ischemic stroke, intraosseous vascular access is a rapid and reliable alternative to IV in administering tenecteplase. Protocolizing the IO route in patients with difficult IV access may minimize door-to-needle time and ultimately improve stroke outcomes.