From the Guidelines
The recommended dose of tenectaplase (TNK-tPA) for unstable pulmonary embolism is a single weight-based intravenous bolus, typically 30-50 mg based on patient weight, as indicated in the most recent guidelines 1.
Key Considerations
- The dose of tenectaplase should be administered as a rapid intravenous bolus over 5-10 seconds in patients with high-risk pulmonary embolism characterized by hemodynamic instability, hypotension, or shock.
- Before administration, patients should be assessed for contraindications to thrombolysis, including recent surgery, active bleeding, or history of intracranial hemorrhage, as outlined in previous guidelines 1.
- Concurrent anticoagulation therapy with heparin is typically continued or initiated after tenectaplase administration.
- Tenectaplase works by activating plasminogen to form plasmin, which degrades the fibrin matrix of the clot, leading to rapid clot dissolution.
- Close monitoring for bleeding complications is essential during and after administration.
Administration Details
- For patients weighing <60 kg, the dose is 30 mg; for 60-69 kg, the dose is 35 mg; for 70-79 kg, the dose is 40 mg; for 80-89 kg, the dose is 45 mg; and for ≥90 kg, the dose is 50 mg, as specified in the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline 1.
- The medication should be administered as soon as possible after diagnosis to restore pulmonary circulation, reduce right ventricular strain, and improve hemodynamic stability in patients with life-threatening pulmonary embolism.
From the Research
Tenectaplase Dose for Unstable Pulmonary Embolism
- The recommended dose of tenectaplase for unstable pulmonary embolism is not explicitly stated in the provided studies, but weight-adjusted dosing is mentioned in several studies 2, 3, 4.
- A study published in 2010 used a weight-adjusted single-bolus tenecteplase dose, similar to that used for acute myocardial infarction, and found it to be feasible and associated with reduction of right ventricle dysfunction at 24 hours in hemodynamically stable patients with pulmonary embolism 2.
- Another study published in 2011 used weight-adjusted dosing of tenecteplase and found it to be effective in treating suspected or confirmed pulmonary embolism, with alleviation of symptoms and significant reduction in tachycardia and increase in oxygen saturation 3.
- A study published in 2004 used a weight-optimized dosing regimen of tenecteplase, administered as an intravenous bolus, and found it to be well tolerated and effective in treating massive and submassive pulmonary embolism 4.
- However, the optimal dose of tenecteplase for unstable pulmonary embolism remains unclear and may require further study to determine the most effective and safe dosing regimen 5.
Key Findings
- Weight-adjusted dosing of tenecteplase may be effective and safe for treating pulmonary embolism 2, 3, 4.
- Tenecteplase may be an alternative thrombolytic to alteplase for treatment of pulmonary embolism or cardiac arrest with suspected pulmonary embolism 5.
- Further studies are needed to compare the different systemic thrombolytic agents for pulmonary embolism or cardiac arrest with suspected pulmonary embolism 5.