Thrombolytics / Fibrinolytics
Tenecteplase (TNK)
TNKase
Recombinant tissue plasminogen activator variant (fibrinolytic)
Bioengineered tPA with greater fibrin specificity, longer half-life, and PAI-1 resistance → single-bolus dosing.
Indications
- •STEMI (single IV bolus)
- •Acute ischemic stroke (increasingly used, off/on-label by region)
- •PE (off-label)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| STEMI | Single weight-based IV bolus 30–50 mg (over 5 sec) | — |
| Stroke | 0.25 mg/kg IV bolus (max 25 mg) per current protocols | — |
Pharmacokinetics
Onset immediate. Half-life ~20–24 min (longer than alteplase) — enables single bolus.
Side effects
- !Hemorrhage (intracranial/systemic)
- !Reperfusion arrhythmias
Contraindications
- ×Active bleeding
- ×Recent hemorrhagic stroke / surgery / trauma
- ×Uncontrolled HTN
- ×Recent neuraxial procedure
Clinical pearls
- ★Single-bolus convenience made it the prehospital/ED STEMI + increasingly the stroke lytic of choice.
- ★Same neuraxial-bleeding precautions as alteplase.
Other drugs in Thrombolytics / Fibrinolytics
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.
