Neurologic assessment after fibrinolytic therapy for myocardial infarction.

in the neuroscience intensive care unit at the University of Virginia Health System in Charlottesville. properties of the fibrinolytic agent and the impact of adjuvant therapies such as antiplatelet and anticoagulant agents must also be considered. Tenecteplase is a variant of tissue plasminogen activator (t-PA) that is genetically engineered to have increased fibrin specificity, a longer half-life (20-24 minutes vs 3-5 min for recombinant t-PA), and resistance to plasminogen activator inhibitor (PAI-1), an endogenous substance that inhibits thrombolysis. The longer half-life allows tenecteplase to be administered as a single bolus, whereas other agents require more complex dosing regimens. In addition, in a large clinical trial, patients treated with tenecteplase had less noncerebral bleeding than patients treated with recombinant t-PA, although the risk of ICH was similar.