From the Guidelines
Tenecteplase (TNK-tPA) has been studied in several clinical trials for the treatment of ST-Elevation Myocardial Infarction (STEMI), with a focus on its use in pharmacoinvasive strategies.
Key Trials
- The TRANSFER-AMI trial 1 compared a pharmacoinvasive strategy using tenecteplase with standard treatment after fibrinolytic therapy and found a significant reduction in the combined primary endpoint of death, reinfarction, recurrent ischemia, new or worsening heart failure, or shock at 30 days.
- The CARESS-in-AMI trial 1 studied the use of half-dose reteplase, abciximab, heparin, and ASA in STEMI patients and found improved outcomes with immediate transfer for PCI.
- The WEST trial 1 compared tenecteplase alone with tenecteplase plus transfer for PCI within 24 hours and found a trend toward a reduction in the 30-day composite endpoint of death or reinfarction.
Pharmacoinvasive Strategy
- The pharmacoinvasive strategy involves the use of fibrinolytic therapy, such as tenecteplase, followed by immediate transfer for PCI.
- This approach has been shown to improve outcomes in high-risk STEMI patients, with a reduction in recurrent infarction or ischemia.
Dosing and Administration
- Tenecteplase is administered as a single weight-adjusted intravenous bolus, making it convenient for use in the pre-hospital setting.
- The recommended dose is 30-50mg, depending on patient weight, with a 50% reduction in dose recommended for elderly patients (>75 years) to reduce the risk of stroke.
Key Takeaways
- Tenecteplase is a effective fibrinolytic agent for the treatment of STEMI, particularly when used in a pharmacoinvasive strategy.
- Immediate transfer for PCI after fibrinolytic therapy is recommended for high-risk STEMI patients.
- The dose of tenecteplase should be adjusted based on patient weight, with a reduced dose recommended for elderly patients.
From the FDA Drug Label
TNKase is a tissue plasminogen activator, indicated to reduce the risk of death associated with acute ST elevation myocardial infarction (STEMI). Initiate treatment as soon as possible after the onset of STEMI symptoms.
The clinical trials conducted on tenecteplase (TNK-tPA) in patients with ST-Elevation Myocardial Infarction (STEMI) are not explicitly mentioned in the provided drug label. However, it is indicated that TNKase is approved for use in STEMI to reduce the risk of death associated with the condition.
- Key Points:
- TNKase is indicated for STEMI
- Treatment should be initiated as soon as possible after STEMI symptoms onset No specific clinical trials are mentioned in the label 2.
From the Research
Clinical Trials on Tenecteplase (TNK-tPA) in STEMI Patients
- The efficacy and safety of tenecteplase in patients with ST-Elevation Myocardial Infarction (STEMI) have been investigated in several clinical trials 3, 4, 5, 6.
- A retrospective cohort study compared tenecteplase and reteplase in patients with acute STEMI, finding no significant difference in failed thrombolysis, but a higher incidence of major bleeding in the reteplase group 3.
- A systematic review and network meta-analysis compared the efficacy and safety of different fibrinolytic agents, including tenecteplase, in STEMI patients, finding that tenecteplase was associated with a lower risk of major bleeding compared to other regimens 4.
- The STREAM-2 study investigated the use of half-dose tenecteplase in older STEMI patients, finding that it was associated with electrocardiographic changes comparable to those after primary PCI, but with a higher risk of intracranial hemorrhage 5, 6.
- The results of these trials suggest that tenecteplase is a viable treatment option for STEMI patients, particularly in situations where primary PCI is not readily available, but highlight the need for careful consideration of the risks and benefits of fibrinolysis in older patients 4, 6.
Key Findings
- Tenecteplase is associated with a lower risk of major bleeding compared to other fibrinolytic agents 4.
- Half-dose tenecteplase is a reasonable alternative to primary PCI in older STEMI patients, but with a higher risk of intracranial hemorrhage 6.
- The efficacy and safety of tenecteplase in STEMI patients require careful consideration of individual patient characteristics and contraindications to fibrinolysis 3, 4, 5, 6.