Recommended Dose of Tenecteplase for Pulmonary Embolism
For pulmonary embolism, tenecteplase should be administered as a single weight-based intravenous bolus according to the following dosing schedule: <60 kg: 30 mg, 60-69 kg: 35 mg, 70-79 kg: 40 mg, 80-89 kg: 45 mg, and ≥90 kg: 50 mg. 1
Dosing Protocol and Administration
- Tenecteplase is administered as a single IV bolus based on patient weight
- No infusion is required after the initial bolus
- The complete weight-based dosing schedule is:
Weight Dose <60 kg 30 mg 60-69 kg 35 mg 70-79 kg 40 mg 70-79 kg 40 mg 80-89 kg 45 mg ≥90 kg 50 mg
Clinical Indications
- Thrombolytic therapy with tenecteplase is primarily indicated for:
- Massive PE (with hemodynamic instability/shock)
- Selected cases of submassive PE with evidence of right ventricular dysfunction
- According to the American College of Cardiology and British Thoracic Society guidelines, thrombolytic therapy is first-line treatment for massive PE 1
Contraindications
- Absolute contraindications include:
- Prior intracranial hemorrhage
- Known structural intracranial cerebrovascular disease
- Active internal bleeding
- Recent stroke
- Recent major surgery or trauma
- Known bleeding diathesis 1
- Relative contraindications include:
- Chronic, severe, poorly controlled hypertension
- Significant hypertension on presentation
- History of prior ischemic stroke >3 months
- Dementia
- Major surgery (<3 weeks)
- Recent internal bleeding
- Noncompressible vascular punctures
- Pregnancy
- Active peptic ulcer
- Concurrent oral anticoagulant therapy 1
Clinical Efficacy and Safety
- Clinical studies have demonstrated the efficacy of tenecteplase in improving right ventricular function and reducing pulmonary artery pressure in PE patients 2, 3
- Tenecteplase has been shown to significantly improve oxygen saturation and alleviate symptoms such as dyspnea and tachycardia 3, 4
- The PEITHO trial demonstrated that tenecteplase was associated with an increased probability of favorable outcomes in patients with submassive PE 5
Important Clinical Considerations
- Always follow tenecteplase administration with standard anticoagulation therapy
- Monitor patients closely for bleeding complications, particularly intracranial hemorrhage
- Establish invasive arterial access for patients with shock/hypotension to guide management 1
- Perform echocardiography before and after treatment to assess improvement in right ventricular function
Practical Administration Tips
- Reconstitute tenecteplase according to manufacturer's instructions
- Administer as a single IV bolus over 5-10 seconds
- Begin standard anticoagulation with unfractionated heparin or low molecular weight heparin after tenecteplase administration
- Monitor vital signs, oxygen saturation, and bleeding sites frequently after administration