Tenecteplase
A modified tissue plasminogen activator given as a single intravenous bolus to dissolve clots in acute ischemic stroke and STEMI.
Also called TNK-tPA (abbreviation).
Drug card
- Class
- Thrombolytic
- How it works
- Turning plasminogen into plasmin, which breaks down the fibrin in clots
- Used for
- Acute ischemic stroke
- Acute STEMI, to lower the risk of death
- Known for
- Bleeding, including intracranial hemorrhage
- Its name
- -plase means a plasminogen activator (clot buster)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does tenecteplase work?
A tPA altered at three places: threonine 103 to asparagine, asparagine 117 to glutamine, and four alanines at positions 296 to 299. Like alteplase it binds fibrin and converts plasminogen to plasmin, but it is more fibrin-specific, so less circulating fibrinogen is broken down. It is cleared mainly by the liver and is given as one bolus.
Like other thrombolytics: They turn plasminogen into plasmin, the enzyme that cuts fibrin apart, so a clot that has already formed dissolves and the blocked vessel can reopen. Alteplase and tenecteplase are recombinant forms of tissue plasminogen activator: they bind fibrin in the thrombus and act mainly on the plasminogen trapped there, so circulating fibrinogen is broken down less.
Uses
What is tenecteplase used for?
- Acute ischemic stroke
- Acute STEMI, to lower the risk of death
Side effects
Side effects of tenecteplase
- Bleeding, including intracranial hemorrhageKnown forSerious
- Orolingual angioedemaSerious
- Allergic reactions, including anaphylaxisSerious
- Cholesterol embolismSerious
- Emboli from a clot in the left heartSerious
- Slow rhythms or ventricular irritabilitySerious
- Heart failure and recurrent ischemia with planned PCISerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated with internal bleeding, brain or spinal surgery or trauma in the past 2 months, a bleeding diathesis, or severe uncontrolled hypertension.
- In STEMI it is also contraindicated after any intracranial hemorrhage or an ischemic stroke within 3 months.
- Large STEMI: choose either thrombolysis or primary PCI; planned PCI straight after it raised heart failure and recurrent ischemia.
- Coagulation and fibrinolysis tests can mislead during treatment, because the drug keeps degrading fibrinogen in the blood sample.
Good to know: Given as a single 5-second bolus, while alteplase needs an infusion; its amino-acid changes make it more fibrin-specific.
Remember it
A way to remember it
Lytics lyse: they make plasmin, and plasmin snips the fibrin that holds a clot together.
Their main danger follows from that action: bleeding, especially at puncture sites and inside the skull. Tranexamic acid works the opposite way, by keeping plasmin off fibrin.
Written for biofideX
Its name
-plase means plasminogen activator (clot buster)
Alteplase and tenecteplase are tissue plasminogen activators that dissolve clots. WHO lists them under -ase (enzymes) as -teplase; urokinase-type ones end in -uplase.
- Every drug name stem
Its class
Thrombolytics
Other thrombolytics with a card:
Easily mixed up with antifibrinolytics and heparins.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Tenecteplase for injection: label (DailyMed)
- Tenecteplase (NCI Thesaurus)
- Alteplase for injection: label (DailyMed)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood clots and cholesterol
Tenecteplase is one of 19 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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