Administration Protocol for Tenecteplase in Myocardial Infarction

Timing and Indications

• The European Society of Cardiology recommends treatment with tenecteplase within 12 hours of symptom onset, with the greatest benefit occurring with earlier administration, in patients with acute ST-elevation myocardial infarction (STEMI) 2
• Consider tenecteplase when primary PCI cannot be performed by an experienced team within 120 minutes of first medical contact, as recommended by the European Heart Journal 3
• For patients presenting very early (<2 hours after symptom onset) with a large infarct and low bleeding risk, fibrinolysis should be considered if time from first medical contact to balloon inflation is >90 minutes, according to the European Heart Journal 1

Adjunctive Therapy

• The European Society of Cardiology recommends administering oral loading dose of 150-300 mg or IV dose of 80-150 mg of aspirin if oral ingestion is not possible, in addition to tenecteplase 1, 3
• The European Society of Cardiology indicates clopidogrel in addition to aspirin, as part of adjunctive therapy for STEMI patients treated with tenecteplase 1, 3
• Anticoagulation is required until revascularization (if performed) or for duration of hospital stay up to 8 days, with preferred options including enoxaparin or unfractionated heparin (UFH), as recommended by the European Heart Journal and the American College of Cardiology 1, 3, 4

Weight-Based Dosing

• The following weight-based dosing table is recommended for tenecteplase administration:

1

Post-Administration Monitoring

• The American College of Cardiology recommends monitoring ST-segment elevation, cardiac rhythm, and clinical symptoms over 60-180 minutes after initiation of therapy, with signs of successful reperfusion including relief of symptoms, maintenance or restoration of hemodynamic and/or electrical stability, and reduction of at least 50% of initial ST-segment elevation on follow-up ECG 60-90 minutes after initiation 4
• Transfer to a PCI-capable center following fibrinolysis is indicated in all patients, and consider rescue PCI immediately if fibrinolysis has failed (<50% ST-segment resolution at 60 minutes), as recommended by the European Heart Journal 1

Special Considerations

• The American College of Cardiology recommends avoiding tenecteplase in patients >75 years when using low molecular weight heparin (LMWH) as ancillary therapy, and avoiding LMWH in patients with significant renal dysfunction (serum creatinine >2.5 mg/dL in men or >2.0 mg/dL in women) 4
• The European Heart Journal recommends considering bivalirudin as an alternative to heparin in patients with known heparin-induced thrombocytopenia 5
• The combination of tenecteplase, aspirin, enoxaparin, and clopidogrel has been extensively studied as part of a pharmacoinvasive strategy, according to the European Heart Journal 3