Tenecteplase (TNK-tPA)

CLASS

  •  thrombolytic

MECHANISM OF ACTION

  • selectively binds to fibrin and converts plasminogen -> plasmin -> degradation of fibrin matrix

PHARMACEUTICS

  • recombinant fibrin specific plasminogen activator
  • known as metalyse
  • white powder for reconsitution

DOSE

  • dosed on body weight
  • < 60kg – 30mg
  • > 50kg – 50mg
  • give as a single bolus over 5-10 seconds

INDICATIONS

  • STEACS within 12 hours

CONTRAINDICATIONS

  • current bleeding disorder or known haemorrhagic diathesis within last 6 months
  • anticoagulation (INR > 1.3)
  • history of CNS damage
  • major within last 2 months
  • prolonged CPR
  • hepatic dysfunction
  • active peptic ulcer disease
  • arterial aneurysm
  • previous haemorrhagic CVA
  • TIA within last 6 months

ADVERSE EFFECTS

  • intracranial haemorrhage (lowest rate comparing alteplase and streptokinase)
  • bleeding anywhere
  • allergy
  • cardiac arrhythmia with reperfusion

MANAGEMENT OF BLEEDING

  • stop TNK
  • if heparin given -> protamine
  • cryoprecipitate (keep fibrinogen > 1)
  • FFP
  • platelets

PHARMACOKINETICS

  • Absorption
  • Distribution
  • Metabolism – hepatic
  • Elimination – t1/2 = 24 minutes, Cl = 12 ml/min

EVIDENCE

Andersen et al, A comparison of coronary angioplasty with fibrinolytic therapy in AMI, N Engl J Med 2003;349:733-742

  • RCT
  • n = 1572
  • STEMI’s
  • ateplase or angioplasty
    -> PCI superior to thrombolysis in terms of reinfarction but not mortality
    -> must transfer to cathlab within 2 hrs

Keeley EC, et al. Primary angioplasty vs IV thrombolytic therapy for AMI: a quantitative review of 23 randomised trials. Lancet 2003;361:13-20.

  • n = 7739
  • STEMI’s
  • PTCA vs thrombolysis
    -> PTCA associated with a significant reduction in short-term mortality, non-fatal reinfarction and combinded end point of death, non-fatal reinfarction and stroke.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.