Executive Summary
Tenecteplase (TNK) is a modified form of the Tissue Plasminogen Activator alteplase, with enhanced fibrin affinity, diminished fibrinogenolysis (greater fibrin-specificity) and Plasminogen Activator Inhibitor-1 (PAI-1) resistance. These properties prolong its half-life permitting administration as a single bolus which is remarkably useful in emergency medicine.
-
Myocardial infarction: fibrinolytic of preference for acute myocardial infarction with ST segment elevation within 12 hours of symptoms (preferably <4 hours) if time to percutaneous coronary intervention will exceed 120 minutes.
-
Acute ischemic stroke: Recently approved by the US-FDA. Guidelines and experts support its use as an alternative to alteplase
-
Cautions: fibrinolysis is a critical and high risk treatment that should not be taken lightly. This intervention must be decided -or at least supported- by a specialist (eg. emergency medicine, neurologist, cardiologist, intensivist).
- Evaluate for individual risk of hemorrhage. Rule out relative and absolute contraindications with checklists (see contraindications).
-
Learn more about fibrinolysis in Fibrinolytics Table and Alteplase.
Adult dose for Acute Myocardial Infarction with ST elevation (STEMI < 12 hrs)
Indicated when anticipated STEMI diagnosis to Percutaneous Coronary Intervention-mediated reperfusion time is >120 min and onset of MI is <12 hrs
Intravenous, bolus
|
|
<60 kg |
30 mg |
60 to <70 kg |
35 mg |
70 to <80 kg |
40 mg |
80 to <90 kg |
45 mg |
≥90 kg |
50 mg (max dose) |
Note: reduce dose to half in patients ≥75 years of age
Adult dose for Acute Ischemic Stroke
Intravenous, bolus
|
|
Less than 60 kg |
15 mg |
60 kg to less than 70 kg |
17.5 mg |
70 kg to less than 80 kg |
20 mg |
80 kg to less than 90 kg |
22.5 mg |
90 kg or more |
25 mg |
For both eligible or ineligible patients to undergo mechanical thrombectomy, dosing over 0.25 mg/kg is not recommended
Adult dose for Pulmonary Embolism (PE)
Not US-FDA approved. Prefer alteplase for PE fibrinolytic therapy. If unavailable, consider tenecteplase.
Intravenous, bolus
|
|
<60 kg |
30 mg |
60 to <70 kg |
35 mg |
70 to <80 kg |
40 mg |
80 to <90 kg |
45 mg |
≥90 kg |
50 mg (max dose) |