5 minutes tNk

Overview

Tenecteplase is a tissue plasminogen activator produced by recombinant DNA technology. It binds to fibrin and catalyzes the conversion of plasminogen to plasmin, which leads to rapid lysis of clots. Thrombolytic therapy with alteplase or tenecteplase is used in the treatment of myocardial infarction,
ischemic stroke, and pulmonary embolism (PE). Alteplase is approved by the US Food and Drug Administration (FDA) for all 3 indications; tenecteplase is FDA approved only for the treatment of myocardial infarction.

Advantages

Institutions cite workflow advantages and potential cost savings with tenecteplase (the wholesale acquisition cost is $8071.39 per 50-mg vial of tenecteplase, as compared with $10 560.43 per 100-mg vial of alteplase).

Tenecteplase has a 6-fold longer half-life, a 15-fold higher fibrin specificity, and an 80-fold increased resistance to plasminogen activator inhibitor 1 when compared with alteplase.

A longer half-life permits a single bolus administration. A single bolus dose offers ease of administration, a potential reduction in medication errors, and a reduction in medication preparation and administration time, which is critical when treating time-sensitive conditions such as stroke.

Higher fibrin specificity decreases the systemic activation of plasminogen and the resulting degradation of circulating fibrinogen, potentially reducing systemic bleeding.

Increased resistance to plasminogen activator inhibitor 1 (which helps ensure that clots remain intact) potentially increases the potency and efficacy of tenecteplase.

trials: Australian trial9 published in 2012, e ATTEST (Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis) 2015, NOR-TEST (Norwegian Tenecteplase Stroke Trial) 2017, EXTEND-IA TNK part 1 trial 2018, EXTEND-IA TNK part 2 trial 2020, Part A of NOR-TEST 2 2022.

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