Tenecteplase for treatment of acute myocardial infarction

OBJECTIVE: To describe the pharmacology, pharmacokinetics, efficacy, and safety of tenecteplase in reducing mortality associated with acute myocardial infarction (AMI). DATA SOURCES: Published articles were identified from MEDLINE (from 1966 to December 2000) and Current Contents (all sections) searches. STUDY SELECTION AND DATA EXTRACTION: Dose-ranging and pivotal studies were included for analysis in the clinical trials section. DATA SYNTHESIS: Tenecteplase is a third-generation thrombolytic indicated for the reduction of mortality associated with AMI. Tenecteplase has a longer half-life that allows for single-dose, intravenous bolus administration. Data from clinical trials support that tenecteplase is similar to alteplase in reducing 30-day mortality rates in patients who have had an AMI. In the ASSENT-2 (Assessment of the Safety and Efficacy of a New Thrombolytic) trial, patients treated with tenecteplase required fewer blood transfusions and experienced fewer episodes of noncerebral bleeding compared with those treated with alteplase. CONCLUSIONS: Tenecteplase is an effective thrombolytic agent for the treatment of AMI. It can be given as a single weight-based dose; however, it appears to offer no significant advantage over other agents in terms of its efficacy or rate of intracranial hemorrhage.