Tenecteplase
📖 About
Always check the BNF link here before prescribing.
- 💉 Tenecteplase is a genetically engineered fibrinolytic agent.
- Used in the management of acute STEMI when primary PCI is unavailable within guideline timeframes.
- More fibrin-specific and longer half-life than alteplase → can be given as a single bolus.
⚙️ Mode of Action
- Activates tissue plasminogen → converts plasminogen to plasmin → breaks down fibrin clots.
- Results in reperfusion of occluded coronary arteries in STEMI.
📋 Indications / Dose (STEMI – within 12 h of symptom onset)
| Weight | IV Bolus Dose (over 10 sec) |
|---|
| <60 kg | 30 mg |
| 60–70 kg | 35 mg |
| 70–80 kg | 40 mg |
| 80–90 kg | 45 mg |
| >90 kg | 50 mg (max) |
💡 Always combine with antiplatelet therapy (aspirin + clopidogrel) and adjunctive anticoagulation (LMWH or UFH) unless contraindicated.
🔄 Interactions
- ⚠️ Increased bleeding risk with anticoagulants (heparin, warfarin, DOACs) or dual antiplatelet therapy.
⛔ Absolute Contraindications
- 📉 Suspected/confirmed aortic dissection.
- 🧠 Ischaemic stroke within last 3 months (unless acute stroke <4.5 h being treated).
- 🧠 Previous intracranial haemorrhage or intracranial neoplasm/AVM.
- 🩸 Active bleeding diathesis or uncontrolled bleeding.
- ⬆️ Severe uncontrolled hypertension (SBP >180 mmHg, DBP >100 mmHg).
- 🤕 Significant head/facial trauma within last 3 months.
- 🧑🔬 Recent intracranial/intraspinal surgery.
- Active cancer with high bleeding risk.
⚠️ Relative Contraindications (seek senior advice)
- Recent GI bleeding or uncontrolled bleeding disorder.
- Prolonged CPR >10 min (risk of trauma-related bleeding).
- Known peptic ulcer disease.
- Current anticoagulation (warfarin, DOACs, LMWH).
- Pregnancy, active menstruation, or post-partum state.
- Retinopathy (haemorrhagic or diabetic).
- Aortic/thoracic aneurysm.
- Major surgery or invasive procedure within last 3 weeks.
⚠️ Side Effects
- 🩸 Bleeding (major complication) – stop heparin/antiplatelets and seek haematology advice if significant.
- 🧠 Intracranial haemorrhage (ASSENT-2 trial: 0.9%).
- Stroke risk ~1.8% (any type), increases with age.
- Other: hypotension, allergic reactions (rare).
📝 Clinical Pearls
- Target door-to-needle time <30 min if PCI unavailable.
- Monitor for reperfusion arrhythmias post-lysis (marker of successful reperfusion).
- Follow with early coronary angiography ± rescue PCI if failed reperfusion.
- Bleeding management: supportive → blood products (cryoprecipitate, FFP, platelets) + antifibrinolytics (e.g. tranexamic acid) if severe.
📚 References
