tenecteplase at a glance
Medicine class
Fibrin-specific thrombolytic, sometimes called a clot-busting treatment.
Licensed roles
Acute ischaemic stroke and selected ST-elevation acute myocardial infarction presentations in adults.
Administration
Injected into a vein by trained healthcare professionals in a monitored setting after reconstitution.
Main safety concern
Bleeding, including potentially disabling or fatal internal bleeding.
What is tenecteplase used for?
Selected UK products have indication-specific licences for adults.
Acute ischaemic stroke when intracranial bleeding has been excluded and treatment can begin within the licensed time window.
Suspected acute myocardial infarction with persistent ST elevation or recent left bundle branch block within the licensed time window.
How does tenecteplase work?
Tenecteplase binds preferentially to fibrin in a clot and converts clot-bound plasminogen into plasmin. Plasmin breaks down the clot’s fibrin framework, which may restore blood flow to affected heart or brain tissue.
tenecteplase preparations and strengths
Injection
Route: Parenteral
Strengths: 25 mg, 5000 units
How to take tenecteplase
Tenecteplase is not taken by mouth or self-administered. Trained staff reconstitute the powder and give it by intravenous injection in an appropriately monitored emergency setting.
The prepared solution should be clear and colourless to slightly yellow, without particles.
It should not be mixed with or administered through a line containing glucose solution.
The intravenous line is flushed after administration to ensure delivery.
tenecteplase side effects
Common or expected effects
- Bleeding or bruising, particularly around injection or puncture sites
- Nosebleed
- Bleeding from the stomach or bowel
- Blood in the urine or other urinary or genital bleeding
Get urgent medical advice
- Bleeding within the brain, which may cause neurological deterioration, severe headache, reduced consciousness or seizure
- Major internal bleeding, including coughing or vomiting blood, black stools or persistent bleeding
- Severe hypersensitivity or angio-oedema with facial, tongue or throat swelling and breathing difficulty
- Serious heart-rhythm disturbance around restoration of coronary blood flow after myocardial infarction
tenecteplase in pregnancy
Human pregnancy information is limited. Because tenecteplase can cause serious bleeding, an experienced specialist must weigh the potential emergency benefit against risks to the pregnant person and pregnancy.
tenecteplase while breastfeeding
It is unknown whether tenecteplase enters human milk. The treating team should advise whether breastfeeding needs to be interrupted temporarily after treatment.
tenecteplase interactions
The main concern is increased bleeding. The treating team needs an accurate recent medicines history.
Anticoagulants, including warfarin, heparins and direct oral anticoagulants
Active anticoagulation can substantially increase bleeding risk and may prevent use, depending on the indication and relevant test results.
Antiplatelets, including aspirin and clopidogrel
Effects on platelet function can increase bleeding risk before, during or after thrombolysis.
Common questions about tenecteplase
Answers are fully visible for fast scanning and source review.
Is tenecteplase a blood thinner?
It is a thrombolytic rather than a conventional anticoagulant. It breaks down fibrin within an existing clot, while anticoagulants mainly reduce further clot formation.
Why is a brain scan needed before tenecteplase for stroke?
It excludes intracranial bleeding because thrombolysis could worsen a haemorrhagic stroke.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.