From the Guidelines
The dose of tenectaplase (TNK-tPA) in a patient with a mechanical mitral valve who has had a stroke is 0.4 mg/kg as a single IV bolus.
Administration Considerations
- Tenecteplase is given as a single IV bolus, as opposed to the 1-hour infusion of alteplase 1.
- The use of tenecteplase as an alternative to alteplase may be considered in patients with minor neurological impairment and no major intracranial occlusion, but its effectiveness and safety profile are similar to those of alteplase 1.
Key Points
- Tenecteplase has been compared to alteplase in several trials, but its superiority or non-inferiority has not been proven 1.
- The largest trial of 1100 subjects failed to demonstrate superiority of tenecteplase over alteplase in a stroke population with minor neurological impairment and no major intracranial occlusion 1.
- The dose of 0.4 mg/kg is based on the available evidence, but it is essential to consider the individual patient's characteristics and medical history, including the presence of a mechanical mitral valve, when making treatment decisions.
Important Considerations
- The guidelines do not provide specific recommendations for patients with mechanical heart valves, so caution should be exercised when administering tenecteplase in these patients 1.
From the Research
Dose of Tenectaplase for Stroke in a Patient with a Mechanical Mitral Valve
- The dose of tenecteplase for acute ischemic stroke is typically 0.25 mg/kg, as indicated by recent randomized controlled trials 2.
- This dose has been shown to be effective and safe for patients with acute ischemic stroke, including those with large vessel occlusions 2, 3.
- For patients with prosthetic valve thrombosis, including those with mechanical mitral valves, tenecteplase has been used at a dose of 40 mg as a bolus dose 4, although the optimal dose for this specific indication is not well established.
- In one study, a lower dose of 25 mg was used successfully in a pregnant patient with prosthetic valve thrombosis 4.
Considerations for Tenecteplase Use in Patients with Mechanical Mitral Valves
- Tenecteplase has been shown to be effective in treating prosthetic valve thrombosis, including in patients with mechanical mitral valves 5, 4, 6.
- The use of tenecteplase in patients with mechanical mitral valves and acute ischemic stroke may be considered, although the optimal dose and treatment strategy are not well established.
- Further studies are needed to determine the safety and efficacy of tenecteplase in this specific patient population.