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Pharmacology · Thrombolytics (fibrinolytics)

Tenecteplase !

An engineered tissue plasminogen activator that lasts longer than alteplase, so it is given as a single bolus in heart attack and stroke.

Updated 2026-11-01

Also called: TNK-tPA

The figure shows full-length human plasminogen, the substrate that tenecteplase cuts into plasmin; the drug itself is not in the crystal.

Target in 3D: Plasminogen (the zymogen of plasmin), bound to fibrin. PDB structure 4DUR (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Tenecteplase is a genetically modified form of tissue plasminogen activator. The changes increase its affinity for fibrin, lengthen its half-life and make it relatively resistant to plasminogen activator inhibitor-1. Like alteplase, it converts fibrin-bound plasminogen into plasmin, which breaks up the clot.

  1. The drug binds fibrin inside the clot
  2. It cuts fibrin-bound plasminogen into plasmin
  3. Plasmin breaks fibrin into degradation products
  4. The artery reopens; blood flow returns

Pharmacokinetics

Half-life
Longer than alteplase, which allows a single intravenous bolus

Indications

Adverse effects

Common

  • Bleeding
  • Bruising and oozing at puncture sites

Contraindications

  • Previous intracranial haemorrhage, or a known cerebral vascular lesion or brain tumour
  • Active bleeding or a bleeding disorder
  • Suspected aortic dissection
  • Recent ischaemic stroke, significant head trauma or brain or spinal surgery
  • Severe uncontrolled hypertension

Key interactions

Heparin, anticoagulants and antiplatelets (aspirin, clopidogrel)
Add to the bleeding risk; serious haemorrhage is more frequent when heparin is given at the same time
Warfarin (raised INR)
Current warfarin use with a raised INR is a relative contraindication

What is monitored

  • Neurological status and blood pressure
  • Signs of bleeding; haemoglobin and coagulation tests
  • Reperfusion: ECG and symptoms in myocardial infarction

Administration and safety

  • Single intravenous bolus, weight-based; check the weight and the calculation
  • Not to be confused with alteplase or reteplase: different doses and schedules

Nursing care

  • Check the time symptoms began and go through the contraindication checklist before the drug is mixed
  • Neurological checks and blood pressure often during and after the infusion; a sudden headache, vomiting or a drop in consciousness suggests intracranial bleeding
  • Look for bleeding at puncture sites, gums, urine and stool
  • Avoid new arterial punctures, intramuscular injections and unnecessary venepunctures

Pregnancy and breastfeeding

There are few data in pregnancy; as with other thrombolytics it is used only when the maternal benefit outweighs the bleeding risk.

Test yourself

Think of the answer, then tap the question to see it.

What practical advantage does tenecteplase have over alteplase?

A longer half-life, so a single bolus is enough.

To which natural inhibitor is it relatively resistant?

Plasminogen activator inhibitor-1 (PAI-1).

Is it more effective than alteplase?

Efficacy and toxicity are similar; the gain is simpler dosing.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Tenecteplase Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 36 (McGraw Hill, 2023); Farmacología básica y clínica (Katzung), 16.ª ed., cap. 34 (McGraw Hill, 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.