Tenecteplase (Stroke)

How it works

It is a fibrin-specific plasminogen activator that converts plasminogen to plasmin at the clot surface, dissolving the occluding thrombus and restoring cerebral perfusion.

Prescribing in practice

• Intracranial haemorrhage is the principal hazard, so it is contraindicated where there is active bleeding, recent intracranial haemorrhage, recent surgery or trauma, or uncontrolled hypertension, and eligibility must follow stroke pathway criteria after imaging excludes haemorrhage.
• It is given as a single intravenous bolus, simplifying administration compared with alteplase infusion, and blood pressure must be controlled before and after treatment.
• Concomitant anticoagulants and recent antiplatelet exposure increase bleeding risk and must be factored into eligibility.

Monitoring

Monitor neurological status, blood pressure and for signs of bleeding closely during and after administration, with urgent imaging if deterioration occurs.

Counselling the patient

• Explain to the patient or family that this is an emergency clot-busting treatment carrying a risk of bleeding into the brain.
• Report any sudden worsening of symptoms, severe headache or new weakness immediately to staff.
• The team will monitor blood pressure and neurology frequently after the dose.

Evidence & guidelines

Randomised trials and stroke guidelines support intravenous tenecteplase as an alternative thrombolytic to alteplase for eligible acute ischaemic stroke patients.