While
thrombolytic agents have demonstrated improved mortality over the use of placebo, this has come at the expense of
bleeding complications such as
intracranial hemorrhage (ICH).
Tenecteplase (
TNK-tPA) is a novel
thrombolytic agent engineered to improve upon the ease of use and safety of
alteplase (t-PA). Given its longer half-life,
TNK-tPA can be administered as a single bolus. The dosing of
TNK-tPA has been weight optimized to enhance both safety and efficacy outcomes. Weight-optimized
TNK-tPA dosing requires
body weight estimation, which may introduce the potential for
medication error. However, data from
TNK-tPA clinical trials suggest that
body weight estimates can err by up to 20 kg (44 lb) without an increased risk of ICH or death. Furthermore, the results of
TNK-tPA clinical trials showed that even at the highest weight-optimized dosage of 50 mg, ICH rates were among the lowest reported in clinical trials of thrombolytics for acute
myocardial infarction. In elderly female patients of low
body weight, the use of weight-optimized
TNK-tPA lowered the risk of ICH compared with the use of t-PA, expanding the potential use of thrombolytics to this high-risk patient population.
Tenecteplase has demonstrated clinical equivalence to t-PA, but with a wider therapeutic margin of safety.