| Drug administration for tenecteplase thrombolysis |
Age under 75 years |
Age 75 years or older |
| Step 1 |
Aspirin 300mg oral (ideally soluble or chewed), if not already given |
Aspirin 300mg oral (ideally soluble or chewed), if not already given |
| Step 2 |
Tenecteplase (TNK) full dose 0.5mg per kg IV (see below) |
Tenecteplase (TNK) half dose 0.25mg per kg IV (see below) |
| Step 3 |
Unfractionated heparin (UFH) 4000 units IV bolus |
No UFH bolus |
| Step 4 |
Clopidogrel 300mg oral |
Clopidogrel 75mg oral |
| Step 5 |
Enoxaparin 1mg/kg bd s.c. (max 100mg per injection for the first two doses) |
Enoxaparin 0.75mg/kg bd s.c. (max 75mg per injection for the first two doses) |
Special considerations:
- If enoxaparin is unavailable and long or delayed transfer, consider UFH 1000 unit i.v. bolus after 2 hours
- If eGFR <30, regardless of age, the enoxaparin s.c. doses are given once daily
- If eGFR <15, enoxaparin is not recommended, UFH IV infusion is preferred with aPTT monitoring
- If patient is taking warfarin, check INR immediately and omit UFH/enoxaparin until INR <2
- If patient is taking DOAC (e.g. edoxaban), omit UFH/enoxaparin until >12hours since last DOAC dose
- If fondaparinux has already been given, administer UFH IV bolus if age <75yrs, omit enoxaparin for 24 hours
- If tenecteplase is unavailable, it can be substituted by alteplase (requires infusion pump, no half-dosing)
|
Tenecteplase (TNK) dosing regimen
|
|
|
Age < 75 yrs
|
Age ≥ 75 yrs
|
|
Weight (kg)
|
TNK (units)
|
TNK (mg)
|
Vol (ml)
|
TNK (units)
|
TNK (mg)
|
Vol (ml)
|
|
< 60
|
6,000
|
30
|
6
|
3,000
|
15
|
3
|
|
60 - < 70
|
7,000
|
35
|
7
|
3,500
|
17.5
|
3.5
|
|
70 - < 80
|
8,000
|
40
|
8
|
4,000
|
20
|
4
|
|
80 - < 90
|
9,000
|
45
|
9
|
4,500
|
22.5
|
4.5
|
|
≥ 90
|
10,000
|
50
|
10
|
5,000
|
25
|
5
|
Unfractionated heparin IV infusion (only if eGFR < 15)
Following IV UFH bolus, start IV UFH infusion of 12 units per kg, up to a maximum of 1,000 units/h for 24 to 48 hours.
Target aPTT: 50 to 70s, or 1.5 to 2.0 times control at 3, 6, 12 and 24h
TAM (Treatments and Medicines) NHS Highland
