United effort key to successful management of heart medication shortage

Health services can transition back to using the heart medication metalyse (tenecteplase) this month, after the Therapeutic Goods Administration (TGA) lifted conservation guidelines for the first time in two years.

The global shortage of tenecteplase, which occurred due to escalating global demand, was expected to continue until the end of 2024. Supplier Boehringer-Ingelheim has built a new production facility to alleviate the shortage, announcing on 15 October that it could now meet pre-shortage demand for the product.

HSV worked closely with the supplier and health services over the duration of the two-year shortage of tenecteplase to manage and allocate critical supplies.

TGA guidelines prioritised supplies of tenecteplase, a thrombolytic medication used to treat patients suffering from stroke and heart attack, for urgent-care clinical settings such as bush-based clinics and Ambulance Victoria. Larger metropolitan and regional health services received supplies of the alternate medication actilyse (alteplase).

HSV’s Head of Supply Chain Surety Paul Callahan says the collective effort of everyone involved resulted in the shortage being successfully managed.

“Everyone adhered to the guidelines and escalated issues appropriately throughout the shortage. We had regular communication with health services, who provided us with stock on hand and usage data,” he says.

While tenecteplase and alteplase are both effective treatments, tenecteplase is the preferred choice for clinicians in an emergency setting for its ease of administration and because it stays in the bloodstream for longer than alteplase.

Nurse Manager Sue Carroll, of Swifts Creek Bush Nursing Centre, which services Swifts Creek and neighbouring communities in Ensay, Omeo, Dinner Plain and Benambra, says the centre was not impacted by the shortage because they received adequate supplies, allocated through Bairnsdale Hospital.

Sue says she is trained to use tenecteplase in cases of acute myocardial infarction – or heart attack – under the Remote Area Nurses Emergency Guidelines.

“Patients are usually transported by helicopter to the nearest tertiary hospital for treatment or, if none is available, they’re taken by ambulance to Bairnsdale Hospital. It can take up to three hours for an ambulance to come from Bairnsdale, collect the patient and bring them to hospital.”

Paul says health services can now resume ordering tenecteplase with the first deliveries of new stock expected within two to four weeks.

HSV’s Surety team will continue to monitor supplies closely during the transition phase.

Tenecteplase is one of the products on the Critical Supplies Register (CSR), a health sector initiative to identify and manage supply chain risks for critical products.

Above image: Swifts Creek Bush Nursing Centre Manager Sue Carroll with colleague Marney Neal.