Tenecteplase: Innovative Fibrinolysis for ST-Segment Elevation Myocardial Infarction (STEMI)

The use of fibrinolytic agents in the early treatment of ST-segment elevation myocardial infarction (STEMI) is known to significantly reduce mortality. Accelerated (“frontloaded”) alteplase is being challenged as the standard of care for pharmacological reperfusion. Alteplase, reteplase, and streptokinase have several limitations. The search for newer agents has focused on developing a fibrinolytic compound with improved safety as well as a pharmacokinetic and pharmacodynamic profile that allows for single-bolus administration, resistance to inactivation by plasminogen activator inhibitor-1, and greater fibrin specificity. Tenecteplase (TNKaseTM) has been shown to be equivalent to alteplase in reducing 30-day mortality in patients with STEMI. However, subgroup data analysis reveals less risk of bleeding and superior efficacy in patients treated between four and six hours after the onset of symptoms. Important research into the use of tenecteplase, in combination with potent antiplatelet agents and low-molecular-weight heparins, has demonstrated improved patient outcomes. It is possible that the safest and most effective tenecteplase combinations might redefine the standard of practice for pharmacological reperfusion in patients