Tenecteplase

Tenecteplase is a recombinant tissue-type plasminogen activator (tPA) used as a thrombolytic agent. It is a genetically modified variant of tPA designed to have a longer plasma half-life, greater specificity for fibrin-bound plasminogen, and resistance to plasminogen activator inhibitor-1, enabling single-bolus administration for rapid clot dissolution.

Tenecteplase activates plasminogen to plasmin, which degrades fibrin and dissolves thrombi. The effect is targeted to the clot, reducing systemic fibrinolysis compared with some other thrombolytics.

Medical use: The principal indication is acute ST-segment elevation myocardial infarction (STEMI) when rapid reperfusion is needed and primary percutaneous coronary intervention is not available or delayed. It is given as a single intravenous bolus; dosing is weight-based. In some countries it is approved for STEMI; it has been studied for acute ischemic stroke and other thrombotic conditions, but STEMI remains the primary approved indication in many guidelines.

Dosing: Administered as a single IV bolus, with the dose determined by the patient’s body weight; exact mg are defined by local guidelines and product labeling.

Safety and contraindications: As with other thrombolytics, major bleeding, including intracranial hemorrhage, is the main risk. Absolute contraindications include active internal bleeding, history of hemorrhagic stroke, recent intracranial surgery or head trauma, known intracranial neoplasm, severe uncontrolled hypertension, pregnancy, and certain bleeding disorders. Use requires careful assessment of risks and benefits.

History and status: Tenecteplase is approved in many countries for STEMI and is one option among reperfusion strategies; primary PCI is often preferred when feasible.