Thrombolysis & Anticoagulation Protocols
Comprehensive protocols for thrombolytic agents and anticoagulants with weight-based dosing and monitoring
Agents
Tenecteplase (TNKase)
Fibrin-specific thrombolytic
Indication
Acute ST-elevation myocardial infarction (STEMI), acute pulmonary embolism, acute ischemic stroke (within 4.5 hours)
Preparation
Reconstitute with provided diluent. Use immediately after reconstitution.
Clinical Notes
- •Fibrin-specific - less systemic fibrinolysis than non-selective agents
- •Single bolus - easier administration than alteplase
- •Preferred agent in STEMI (ASSENT-2 trial)
- •Time is muscle - minimize door-to-needle time
- •Adjunctive antiplatelet therapy (aspirin, P2Y12 inhibitor) required
- •Adjunctive anticoagulation (heparin, enoxaparin) required
- •Percutaneous coronary intervention (PCI) preferred over thrombolysis if available
Evidence
Grade: 1A
- ACC/AHA Guidelines for STEMI Management 2013
- ASSENT-2 Trial - Lancet 1999
- Antman EM, et al. Circulation 2004