Thrombolytics shortages – A critical challenge

The recent announcement regarding the global shortage of Alteplase and Tenectoplase expected until the end of 2023 and due to ‘manufacturing constraints’, has largely gone unnoticed by the international medical community. ¹ The communication has been released by the Boehringer Ingelheim, which represents the only manufacturer of these thrombolytics in UK and others Western countries. As known, Alteplase is currently licenced for thrombolytic treatment of acute ischaemic stroke, myocardial infarction (MI) and pulmonary embolism (PE) in patients hemodynamically unstable while Tenecteplase for MI. The shortages of lifesaving drugs are inevitably associated with decreased quality of care, conferring significant challenges to heath care systems. ² Over the years the cost of alteplase has significantly increased. ³ Moreover, systemic thrombolysis remains largely underused in some clinical conditions, as acute PE, despite been able to significantly reduce the short-term mortality. ⁴ Moreover, hospital medication shortages also raise several ethical issues since some patients would not receive the optimal reperfusion treatment recommend by the current guidelines. ⁵ Although some health care authorities have suggested to implement the conservation methods of these fibrinolytics or to prioritise the treatment of some patients, the future appears to be problematic. Fixing the problem is difficult and multifaceted, requiring the resolution of current shortages and to prevent future ones. Physicians must consider also alternative therapeutic approaches where they exist while medical community should also think about to new thrombolysis guidance and potential alternatives.