Contraindications and Considerations for TNKase (Tenecteplase) Use

Absolute Contraindications

• Any prior intracranial hemorrhage is an absolute contraindication for TNKase use, as recommended by the American Heart Association 1, 2
• Known structural cerebral vascular lesion (e.g., arteriovenous malformation) is an absolute contraindication for TNKase use, according to the American College of Cardiology 1, 2
• Known malignant intracranial neoplasm (primary or metastatic) is an absolute contraindication for TNKase use, as stated by the American Heart Association 1, 2
• Ischemic stroke within 3 months is an absolute contraindication for TNKase use, as recommended by the American College of Cardiology 1, 2
• Suspected aortic dissection is an absolute contraindication for TNKase use, according to the American Heart Association 1, 2
• Significant closed-head or facial trauma within 3 months is an absolute contraindication for TNKase use, as stated by the American College of Cardiology 1, 2

Relative Contraindications

• History of chronic, severe, poorly controlled hypertension is a relative contraindication for TNKase use, as recommended by the American Heart Association 1, 2
• Significant hypertension on presentation (SBP >180 mm Hg or DBP >110 mm Hg) is a relative contraindication for TNKase use, according to the European Society of Cardiology 1, 3
• History of prior ischemic stroke >3 months is a relative contraindication for TNKase use, as stated by the American College of Cardiology 1, 2
• Dementia is a relative contraindication for TNKase use, as recommended by the American Heart Association 1, 2
• Known intracranial pathology not covered in absolute contraindications is a relative contraindication for TNKase use, according to the American College of Cardiology 1, 2
• Traumatic or prolonged (>10 min) cardiopulmonary resuscitation is a relative contraindication for TNKase use, as stated by the European Society of Cardiology 1, 3
• Major surgery (<3 weeks) is a relative contraindication for TNKase use, as recommended by the American Heart Association 1, 2
• Recent (within 2 to 4 weeks) internal bleeding is a relative contraindication for TNKase use, according to the American College of Cardiology 1, 2
• Noncompressible vascular punctures is a relative contraindication for TNKase use, as stated by the American Heart Association 1, 2
• Pregnancy is a relative contraindication for TNKase use, as recommended by the American College of Cardiology 1, 2
• Active peptic ulcer is a relative contraindication for TNKase use, according to the American Heart Association 1, 2
• Current use of oral anticoagulant therapy is a relative contraindication for TNKase use, as stated by the American College of Cardiology 1, 2

Special Considerations

Timing Considerations

• TNKase is indicated for use within 12 hours of symptom onset in STEMI, as recommended by the American Heart Association 1
• Use beyond the 12-hour window should only be considered in specific circumstances where benefits may outweigh risks, such as in symptomatic STEMI patients with large areas of myocardium at risk or hemodynamic instability when PCI is unavailable, according to the American College of Cardiology 4

Clinical Decision-Making Algorithm

• Evaluate relative contraindications - carefully weigh risk-benefit ratio, as recommended by the American Heart Association 1
• Assess time from symptom onset (optimal benefit within 12 hours), according to the American College of Cardiology 1
• Consider alternative reperfusion strategies (primary PCI) when available, as stated by the American Heart Association 4