BLACK BOX WARNING
- intracranial hemorrhage risk
tenecteplase
Brand: TNKase
⚠ BBW ISMP High Alert Prototype: alteplase
Drug Class: thrombolytic agent
Drug Family: thrombolytic
Subclass: recombinant tissue plasminogen activator (tPA) — modified
Organ Systems: cardiovascularhematology-oncology
Mechanism of Action
Genetically engineered variant of alteplase with three amino acid substitutions that increase fibrin specificity, extend plasma half-life, and confer resistance to PAI-1 inhibition; converts fibrin-bound plasminogen to plasmin for clot dissolution with single IV bolus administration.
plasminogen (fibrin-bound)fibrin clot
Indications
- acute STEMI
Contraindications
- active internal bleeding
- history of CVA
- intracranial or intraspinal surgery or trauma within 2 months
- intracranial neoplasm
- AV malformation or aneurysm
- severe uncontrolled hypertension
- suspected aortic dissection
- significant closed-head or facial trauma within 3 months
Adverse Effects
Common
- bleeding at puncture sites
- ecchymosis
Serious
- intracranial hemorrhage
- major systemic bleeding
- cholesterol embolism syndrome
Pharmacokinetics (ADME)
| Absorption | IV bolus administration only |
| Distribution | blood volume; Vd approximately 6-10 L |
| Metabolism | hepatic; endocytosis via LRP1 receptor |
| Excretion | hepatic clearance |
| Half-life | approximately 20-24 minutes (initial); 90-130 minutes (terminal) — significantly longer than alteplase |
| Onset | immediate |
| Peak | end of bolus |
| Duration | fibrinolysis for 1-2 hours after bolus |
| Protein Binding | low |
| Vd | 6-10 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| anticoagulants and antiplatelet agents | additive bleeding risk | major |
| heparin (initiated after tenecteplase) | used concurrently in STEMI protocol; timing critical to avoid hemorrhagic complications | moderate |
Nursing Considerations
- Tenecteplase is administered as a single weight-based IV bolus (maximum 50 mg) over 5 seconds — confirm exact body weight and dose calculation before administration.
- Use a dedicated IV line; do not administer with dextrose solutions — flush line with normal saline before and after; reconstitute with supplied diluent only.
- Monitor for bleeding at all access sites; apply direct pressure to non-compressible sites; watch for signs of intracranial hemorrhage (acute neurological change) — stop infusion and notify physician immediately.
- Heparin is initiated concurrently per STEMI protocol; monitor aPTT, ECG for reperfusion arrhythmias, and clinical signs of restored coronary flow.
Clinical Pearls
- Tenecteplase's major clinical advantage over alteplase for STEMI is single-bolus administration over 5 seconds versus a 90-minute alteplase infusion, simplifying administration particularly in pre-hospital and ED settings.
- Weight-based dosing of tenecteplase (30-50 mg based on body weight) reduces systemic bleeding compared with the fixed alteplase STEMI dose while maintaining equivalent coronary reperfusion rates.
Safety Profile
Pregnancy use-with-caution
Lactation insufficient-data
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.