Tenecteplase

Chemical

Recombinant version of the naturally occurring glycoprotein (TNK – rTPA)

Use

ST elevation AMI <12hrs

Presentation

Vial of 40/50mg

  • 40mg = 8000U tenecteplase
  • 50mg = 10,000U tenecteplase
  • + sterile water for reconstitution

Dose

Weight based

  • <60kg = 30mg
  • >90kg = 50mg

Single bolus over 10 secs

Route

IV bolus

Onset / DoA

Immediate

t ½ 30 mins

Terminal t ½ 120mins

MoA (mechanism)

  • Binds to fibrin on a clot
  • Converts plasminogen-bound to thrombus – into PLASMIN
  • ∴causes fibrin degradation of clot

Tenecteplase has higher fibrin specificity cf. alteplase (a longer t ½ ∴ only need 1 bolus dose)

PK

A

D

VD 6L

M

Liver → catabolism to small peptides

E

Plasma 120mL/min

Adverse Effects

→ Needs reconstitution

  • Intracranial bleeding
  • Serious bleeding
  • Superficial bleeding
  • Allergic reactions
  • Hypotension

Monitoring

Neuro, BP, ECG → for bleeding signs 24hrs

Reversal

FFP + PRBC + CRYO +/- Antifibrinolytics

CI

  • Significant bleeds <6m
  • Evidence of intracranial/SAH
  • CNS neoplasm
  • Severe uncontrolled HTN
  • CPR <10days
  • Major surgery <3 months
  • Ulcer disease < 3 months
  • Arterial aneurysm/AV malformation
  • Severe hepatic dysfunction