Tenecteplase Flashcards
Tenecteplase Mechanism of action
• Tenecteplase is a fibrinolytic that accelerates the breakdown of blood clots.
It converts the plasma protein plasminogen into the active enzyme plasmin, which breaks down fibrin within blood clots.
Tenecteplase Contraindications (7)
Known severe allergy.
Suspected aortic dissection.
Major surgery, major trauma or severe brain injury within the last six weeks.
Intracranial surgery within the last six months.
Ischaemic stroke within the last six months.
Previous intracerebral haemorrhage.
Known cerebral aneurysm, arteriovenous malformation or tumour.
Tenecteplase Cautions (14)
Clinically significant bleeding.
More than ten minutes of CPR.
Non-compressible vascular puncture within the last 24 hours.
Internal bleeding within the last six weeks.
Lumbar puncture or epidural insertion within the last six weeks.
TIA within the last three months.
Known bleeding disorder.
Taking an anticoagulant. If the patient is taking warfarin document their last
known INR result if possible.
Systolic BP greater than 180 mmHg or diastolic BP greater than 110 mmHg.
Known to be pregnant or less than two weeks postpartum.
Time of onset of symptoms was greater than 12 hours ago.
Dependent on others for activities of daily living.
Another disease significantly shortens their life expectancy.
Very frail.
Tenecteplase Use in pregnancy/breastfeeding
Administration during pregnancy or within two weeks of birth carries a significant risk of bleeding. The likelihood of STEMI occurring in a woman who
is pregnant or within two weeks of birth is very low and personnel must seek clinical advice or discuss with the STEMI coordinator prior to administration.
• May be administered if the patient is breastfeeding. Advise the patient to stop breastfeeding and seek further advice from their lead maternity carer or GP.
Tenecteplase Dose
• Dosage is based on age and known (or estimated) weight. See table in CPGs
Tenecteplase Administration
- Dissolve the powder using the syringe within the kit.
- Carefully discard unwanted drug from the syringe, preferably into the ampoule before administration, ensuring the correct dose remains in the syringe.
- If an error is made in discarding unwanted drug and the correct dose cannot be drawn up, administer the remaining drug and update the STEMI coordinator.
- Administer undiluted as an IV bolus, preferably into a running IV line.
Tenecteplase Common adverse effects
• Bleeding. Tenecteplase commonly causes superficial bleeding, including epistaxis, bruising and bleeding from IV sites.
• Dysrhythmia. It is common for dysrhythmia to occur if the coronary arterybreperfuses. Most commonly the rhythm is accelerated idioventricular rhythm
(AIVR) which does not require specific treatment. Other dysrhythmias shouldbbe treated using the appropriate section.
Tenecteplase Usual onset of effect
5-10 minutes
Tenecteplase Usual duration of effect
2-6 hours
Tenecteplase Pharmacokinetics
- Tenecteplase is metabolised by the liver.
* There are no significant effects from liver impairment on acute administration.
Tenecteplase Preparation
• Glass ampoule containing 50 mg of tenecteplase, in powder form with a
pre-filled syringe containing 10 ml of sterile water.
Tenecteplase Common interactions
None
Tenecteplase and bleeding
• Rarely, tenecteplase may be associated with severe internal bleeding and this is why frequent vital sign recording is required post administration.
• The most common life-threatening bleeding following tenecteplase administration is spontaneous intracerebral bleeding. Patients aged greater
than or equal to 75 years are particularly at risk and this is why the dose is reduced in this age group. If intracerebral bleeding occurs the patient will
usually have sudden onset of headache, a falling level of consciousness, vomiting and focal neurological signs.
Tenecteplase IV considerations
• Do not place additional IV lines after the administration of tenecteplase unless absolutely necessary, as this further increases the risk of bleeding.
