Inj tenectaplase
Reading File
Finding Sources
Good hits from multiple textbooks. Let me read the most comprehensive sections in parallel.
Reading File
Reading File
Reading File
Now let me get dosing details and indications:
Reading File
Reading File
I now have comprehensive information. Let me compile a complete answer.
Injection Tenecteplase (TNK-tPA)
Drug Class
Third-generation fibrinolytic (thrombolytic) agent — a genetically engineered variant of tissue plasminogen activator (tPA).
Mechanism of Action
Tenecteplase activates plasminogen to plasmin, which degrades fibrin clots. Three key genetic modifications distinguish it from alteplase:
| Modification | Effect |
|---|---|
| New glycosylation site added to kringle-1 domain | Longer half-life (20–24 min vs. ~5 min for alteplase) |
| Removal of existing glycosylation site on kringle-1 | Restores fibrin affinity |
| Tetra-alanine substitution at residues 296–299 | 80× greater PAI-1 resistance than alteplase |
- 14× more fibrin-specific than alteplase → selective clot lysis, less systemic fibrinogenolysis
- Does not stimulate thrombin-antithrombin complex formation (unlike streptokinase and alteplase), potentially reducing bleeding risk
- Lower affinity for (DD)E fragment → less systemic plasminogen activation
— Tintinalli's Emergency Medicine, Braunwald's Heart Disease, Harrison's Principles of Internal Medicine 22E
Indications
- STEMI (ST-elevation myocardial infarction) — primary indication when PCI is not available within 120 minutes
- Acute Ischemic Stroke — used in many countries; AHA/ASA 2018 guidelines give a Class IIb recommendation as an alternative to alteplase
Dosing
STEMI
Weight-based single IV bolus (advantage: no infusion required):
| Body Weight | Dose |
|---|---|
| < 60 kg | 30 mg |
| 60–69 kg | 35 mg |
| 70–79 kg | 40 mg |
| 80–89 kg | 45 mg |
| ≥ 90 kg | 50 mg (maximum) |
- Given as a single IV bolus over 5–10 seconds
Acute Ischemic Stroke
- 0.25 mg/kg IV bolus over 5 seconds, maximum 25 mg
- (Lower dose than for STEMI — higher doses associated with increased ICH risk)
— Swanson's Family Medicine Review, Harrison's 22E, Rosen's Emergency Medicine
Comparison with Alteplase (in STEMI)
- Equal 30-day mortality (non-inferior in phase III trial of >16,000 patients)
- Similar intracranial hemorrhage rates
- Less non-cerebral bleeding and reduced need for blood transfusions
- Simpler administration (single bolus vs. weight-adjusted infusion) → fewer medication errors
Contraindications
Absolute:
- Any prior intracranial hemorrhage
- Known intracranial structural lesion (AVM, tumor)
- Ischemic stroke within 3 months (except acute stroke within 4.5 h)
- Suspected aortic dissection
- Active bleeding / bleeding diathesis
- Significant head/facial trauma within 3 months
Key Advantages Over Alteplase
- Single-bolus administration (no infusion) → improves workflow, simplifies transfer to cath lab / thrombectomy centre
- Higher fibrin specificity → less systemic plasmin generation
- PAI-1 resistant → prolonged clot-bound activity
- Fewer non-cerebral bleeding complications
Important Notes
- Administer with concomitant anticoagulation (unfractionated heparin or enoxaparin) per STEMI protocol
- In stroke, tenecteplase obviates need for a 1-hour infusion, simplifying transfer for mechanical thrombectomy
- Not associated with allergic reactions (unlike streptokinase)
— Braunwald's Heart Disease, Tintinalli's Emergency Medicine, Harrison's Principles of Internal Medicine 22E, Rosen's Emergency Medicine
This is a shared conversation. Sign in to Orris to start your own chat.