Tenecteplase

Question 1

What is tenecteplase?

Answer 1

Tenecteplase (50mg(10 000 IU) powder & solvent) is a thrombolytic agent which combines with the fibrin component of the thrombus and converts thrombus-bound plasminogen to plasma. This degrades the fibrin matrix of the thrombus.

Hepatic metabolism

Onset: 15 min
Duration: several hrs
Half-life: 2 hrs

Question 2

Indications for tenecteplase?

Answer 2

1. Patient with STEMI who meet the criteria for prehospital tenecteplase administration (as defined by the relevant QAS coronary artery perfusion checklist)

Question 3

Contraindications for tenecteplase?

Answer 3

1. Patients less than 18 or greater than 75 years of age
2. Uncontrolled hypertension (SBP >180 / DBP >110 mmHg at any stage during current episode)
3. Allergy/ADR to any of: tenecteplase, enoxaparin or clopidogrel
4. LBBB identified on 12-lead ECG
5. Current or history of thrombocytopenia
6. Active tuberculosis
7. Known cerebral disease, in particular a malignant intracranial neoplasm or arteriovenous malformation
8. Prior intracranial haemorrhage
9. Ischaemic stroke or TIA in last 3 months
10. History of significant close head or facial trauma within last 3 months
11. Internal bleeding within last 6 weeks (excludes menses)
12. Bleeding or clotting disorder
13. Current use of anticoagulants (e.g. warfarin)
14. Non-compressive vascular punctures
15. Prolonged (>10 min) CPR
16. Known to be pregnant/delivered within last 2 weeks
17. History of serious systemic disease (advanced stage/terminal cancer, severe liver or kidney disease)
18. Resident of an aged care facility requiring significant assistance with ADL
19. Acute myocardial infarction in the setting of trauma

Question 4

Precautions for tenecteplase?

Answer 4

Nil

Question 5

Side effects of tenecteplase?

Answer 5

1. Haemorrhage

2. Post-administration dysrhythmias

Question 6

What is the dose of tenecteplase for an adult?

Answer 6

Weight calculated:
<60 kg - 30mg (6mL) 
>60 to <70 kg - 35mg (7mL) 
>70 to <80 kg - 40mg (8mL) 
>80 to <90 kg 45mg (9mL) 
>90kg - 50mg (10mL)