From the Guidelines
Tenecteplase is contraindicated in patients with acute ischemic stroke who have a high risk of bleeding complications, including active internal bleeding, intracranial hemorrhage, suspected subarachnoid hemorrhage, and history of intracranial hemorrhage. The contraindications for using Tenecteplase (tissue plasminogen activator) in patients with acute ischemic stroke are similar to those for alteplase, as both are tissue plasminogen activators. According to the 2018 guidelines for the early management of patients with acute ischemic stroke 1, the contraindications for IV alteplase, which can be applied to tenecteplase, include:
- Active internal bleeding
- Intracranial hemorrhage
- Suspected subarachnoid hemorrhage
- History of intracranial hemorrhage
- Significant head trauma within 3 months
- Ischemic stroke within 3 months (except the current acute event)
- Intracranial or intraspinal surgery within 3 months
- Intracranial neoplasm
- Arteriovenous malformation or aneurysm
- Known bleeding diathesis
- Coagulopathy, including platelets <100,000/mm3, INR >1.7, aPTT >40 s, or PT >15 s
- Recent use of low molecular weight heparin (LMWH) within 24 hours
- Use of direct thrombin inhibitors or direct factor Xa inhibitors within 48 hours
- Glycoprotein IIb/IIIa receptor inhibitors
- Infective endocarditis
- Aortic arch dissection
- Intra-axial intracranial neoplasm These contraindications exist because tenecteplase works by dissolving blood clots, which can exacerbate bleeding in patients with pre-existing hemorrhage or high bleeding risk conditions. The time-based contraindications reflect the period during which tissues remain vulnerable to hemorrhagic transformation after various procedures or events 1.
From the FDA Drug Label
TNKase is contraindicated in patients with: Active internal bleeding History of cerebrovascular accident Intracranial or intraspinal surgery or trauma within 2 months Intracranial neoplasm, arteriovenous malformation, or aneurysm Known bleeding diathesis Severe uncontrolled hypertension
The contraindications for using Tenecteplase (tissue plasminogen activator) in patients with acute ischemic stroke are:
- Active internal bleeding
- History of cerebrovascular accident
- Intracranial or intraspinal surgery or trauma within 2 months
- Intracranial neoplasm, arteriovenous malformation, or aneurysm
- Known bleeding diathesis
- Severe uncontrolled hypertension 2 2
From the Research
Contraindications for Tenecteplase (TNK) in Acute Ischemic Stroke
- The provided studies do not explicitly list contraindications for tenecteplase in acute ischemic stroke patients 3, 4, 5, 6, 7.
- However, the studies discuss the risks and complications associated with tenecteplase, such as intracranial hemorrhage (ICH) and symptomatic ICH 3, 4, 5.
- The studies suggest that tenecteplase has a similar risk of ICH to alteplase, with a low incidence of symptomatic ICH 3, 5.
- The American Heart Association guidelines are mentioned as suggesting tenecteplase as an alternative to alteplase for acute ischemic stroke treatment, implying that the contraindications for tenecteplase may be similar to those for alteplase 6.
- The studies do not provide a comprehensive list of contraindications for tenecteplase in acute ischemic stroke patients, but rather focus on comparing its efficacy and safety to alteplase 3, 4, 5, 6, 7.
Comparison of Tenecteplase and Alteplase
- The studies compare the efficacy and safety of tenecteplase to alteplase in acute ischemic stroke patients, with some studies suggesting that tenecteplase may have a similar or slightly better safety profile 3, 4, 5, 6.
- The doses of tenecteplase used in the studies range from 0.25 mg/kg to 0.4 mg/kg, with some studies suggesting that the 0.25 mg/kg dose may be more effective or have a better safety profile 4, 5.
- The studies discuss the potential benefits of tenecteplase, including its ease of administration, cost savings, and potential for improved outcomes in certain patient populations 4, 5, 6.