Tenecteplase

Recombinant Tissue Plasminogen Activator (rt-PA)
1. Serine protease that binds Fibrin and converts Fibrin-bound plasminogen to plasmin
  1. TNK has a higher Specificity for Fibrin than Alteplase (t-PA)
2. Plasmin breaks down both Fibrin and Fibrinogen to Fibrin
  1. Fibrin Degradation Products result, which in turn also act to inhibit Fibrin formation

ST Elevation Myocardial Infarction (STEMI)
1. Give a single IV bolus dose over 5 seconds
2. Once reconstituted, IV solution must be used within 8 hours
3. Use 1/2 dose in age >75 years
4. Weight <60 kg: 30 mg IV (6000 units)
5. Weight 60 to 69 kg: 35 mg IV (7000 units)
6. Weight 70 to 79 kg: 40 mg IV (8000 units)
7. Weight 80 to 89 kg: 45 mg IV (9000 units)
8. Weight >=90 kg: 50 mg IV (10,000 units)
Massive Pulmonary Embolism (off-label)
1. Same dose as in STEMI
Cerebrovascular Accident (off-label but common use within 4.5 hours of CVA onset)
1. Give a single 0.25 mg/kg (up to 25 mg) IV over 5 to 10 seconds
Central venous catheter Occlusion
1. Weight >30 kg
  1. Inject 2 mg in 2 mL into the occluded catheter
  2. Consider a second dose in 2 hours
2. Weight <30kg
  1. Inject the equivalent of 110% of catheter lumen volume (up to max 2 mg in 2 ml solution)
References
1. Pearlman and Nickson (2024) Life in the Fastlane, accessed 10/2/2026
  1. https://litfl.com/tenecteplase-tnk-tpa/