Makindo Medical Notes

📖 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)

💡 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

• BNF – Tenecteplase
• ASSENT-2 Trial: NEJM 1999 – Tenecteplase vs Alteplase in STEMI