Tenecteplase dosing for MI
Reading File
Searching the Web
tenecteplase dosing STEMI MI 2024 guidelines
Finding Sources
Searching PubMed
tenecteplase STEMI fibrinolysis dosing
Reading File
Reading File
Reading File
Here is the complete, verified tenecteplase dosing reference for MI (STEMI):
Tenecteplase (TNK-tPA) Dosing for STEMI
Standard Weight-Based IV Bolus Dose (0.5 mg/kg)
| Patient Weight | Dose | Volume (5 mg/mL) |
|---|---|---|
| < 60 kg | 30 mg | 6 mL |
| 60-69 kg | 35 mg | 7 mL |
| 70-79 kg | 40 mg | 8 mL |
| 80-89 kg | 45 mg | 9 mL |
| ≥ 90 kg | 50 mg | 10 mL |
Maximum dose: 50 mg
Administration
- Single IV bolus over 5-10 seconds
- IV administration only; incompatible with dextrose-containing solutions (use NS-primed line)
- Reconstitute with 10 mL sterile water for injection; final concentration = 5 mg/mL
- If not used immediately: refrigerate and use within 8 hours; do NOT freeze
- Initiate as soon as possible after symptom onset (fibrinolysis most effective in first 3 hours; indicated within 12 hours)
Age Adjustment (>75 years)
Half the standard dose (0.25 mg/kg, max 25 mg) is recommended for patients over 75 years old, based on the STREAM trial data, which showed a lower rate of intracranial hemorrhage (ICH) with half-dose tenecteplase in this age group.
When to Use (Indications)
- STEMI (ST elevation, new LBBB, or true posterior MI) within 12 hours of symptom onset
- PCI not available within 120 minutes of first medical contact
- Administer within 30 minutes of initial patient contact ("door-to-needle" goal)
- Transfer to PCI-capable center should still occur after fibrinolysis
Adjunctive Therapy
Tenecteplase must be given alongside:
- Aspirin (antiplatelet)
- Clopidogrel (antiplatelet; prasugrel and ticagrelor lack evidence with fibrinolytics)
- Anticoagulation (unfractionated heparin or enoxaparin) - goal aPTT 1.5-2.5x control
- Do NOT combine with GP IIb/IIIa inhibitors
Why Tenecteplase is Preferred
- Current agent of choice over alteplase (rt-PA) due to:
- Equivalent mortality benefit
- Simpler single-bolus dosing (fewer medication errors)
- Lower non-cerebral bleeding rates (ASSENT-2 trial)
- 14-fold greater fibrin specificity vs. alteplase
- 80-fold greater PAI-1 resistance (prolongs clot association)
- Half-life of 20-24 minutes (vs. <5 min for alteplase)
Absolute Contraindications (key ones)
- Any prior intracranial hemorrhage
- Known structural cerebral vascular lesion (e.g., AVM)
- Ischemic stroke within 3 months
- Active internal bleeding (excluding menses)
- Aortic dissection (suspected)
- Significant closed head/facial trauma within 3 months
- Prior neurosurgery within 2 months
- Intracranial/intraspinal neoplasm
Sources: Washington Manual of Medical Therapeutics (Table 4-18); Tintinalli's Emergency Medicine; ASSENT-2 trial / official TNKase prescribing information
This is a shared conversation. Sign in to Orris to start your own chat.