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Tenecteplase

    DEA Class; Rx

    Common Brand Names; TNK tPA, TNKase

    • Thrombolytics

    Recombinant thrombolytic agent given as single IV bolus for AMI
    Longer half-life, increased fibrin specificity, and increased resistance to PAI-1 compared to alteplase with similar clinical outcomes of 30-day mortality, intracranial bleeding, and minor bleeding
    Major (non-cerebral) bleeding and blood transfusions were lower with tenecteplase (ASSENT 2 trial) compared to alteplase

    Indicated for the treatment of acute myocardial infarction with ST-elevation (STEMI) due to coronary artery thrombosis.

    For re-establishing patency of an occluded IV catheter or occluded arteriovenous (AV) cannula.
    For the treatment of acute ischemic stroke.

    Hypersensitivity

    Active bleeding, history of CVA, recent (within 2 months) intracranial or intraspinal surgery or trauma, intracranial neoplasm, AVM, aneurysm, bleeding diathesis, severe uncontrolled HTN, recent (within 3 mth) facial trauma, suspected aortic dissection

    Minor bleeding (22%)

    Reperfusion arrhythmias

    MI

    Fever

    Nausea

    Vomiting

    Cholesterol embolization

    Allergic reaction

    Hypersensitivity, including urticarial/anaphylactic reactions, reported after administration of TNKase (eg, anaphylaxis, angioedema, laryngeal edema, rash, and urticaria); monitor patients treated with TNKase during and for several hours after infusion; if symptoms of hypersensitivity occur, initiate appropriate therapy

    Standard management of myocardial infarction should be implemented concomitantly with TNKase treatment; arterial and venous punctures should be minimized; noncompressible arterial puncture must be avoided and internal jugular and subclavian venous punctures should be avoided to minimize bleeding from the non-compressible sites

    The use of thrombolytics can increase the risk of thrombo-embolic events in patients with high likelihood of left heart thrombus, such as patients with mitral stenosis or atrial fibrillation

    Readministration of plasminogen activators, including TNKase, to patients who have received prior plasminogen activator therapy has not been systematically studied; although sustained antibody formation in patients receiving one dose of TNKase has not been documented,readministration should be undertaken with caution

    There are no adequate and well-controlled studies in pregnant women; therapy should be given to pregnant women only if potential benefits justify potential risk to fetus

    Not known if this drug is excreted in human milk; because many drugs are excreted in human milk, exercise caution when this drug is administered to a nursing woman

    Adults

    50 mg/total dose IV.

    Geriatric

    50 mg/total dose IV.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    Tenecteplase

    powder for injection

    • 50mg