Document Detail


Review of tenecteplase (TNKase) in the treatment of acute myocardial infarction.
MedLine Citation:
PMID:  19436656     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
TNKase is a genetically engineered variant of the alteplase molecule. Three different mutations result in an increase of the plasma half-life, of the resistance to plasminogen-activator inhibitor 1 and of the thrombolytic potency against platelet-rich thrombi. Among available agents in clinical practice, TNKase is the most fibrin-specific molecule and can be delivered as a single bolus intravenous injection. Several large-scale clinical trials have enrolled more than 27,000 patients with acute myocardial infarction, making the use of this drug truly evidence-based. TNKase is equivalent to front-loaded alteplase in terms of mortality and is the only bolus thrombolytic drug for which this equivalence has been formally demonstrated. TNKase appears more potent than alteplase when symptoms duration lasts more than 4 hours. Also, TNKase significantly reduces the rate of major bleeds and the need for blood transfusions. The efficacy of TNKase may be further improved by enoxaparin substitution for unfractionated heparin, provided that enoxaparin dose adjustment is made for patients more than 75 years old. Hitherto, the small available randomized studies and international clinical registries suggest that pre-hospital TNKase is as effective as primary angioplasty, thus laying the foundations for a new fibrinolytic, TNKase-based strategy as the backbone of reperfusion in acute myocardial infarction.
Authors:
Giovanni Melandri; Fabio Vagnarelli; Daniela Calabrese; Franco Semprini; Samuele Nanni; Angelo Branzi
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-04-08
Journal Detail:
Title:  Vascular health and risk management     Volume:  5     ISSN:  1178-2048     ISO Abbreviation:  Vasc Health Risk Manag     Publication Date:  2009  
Date Detail:
Created Date:  2009-05-13     Completed Date:  2009-06-19     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  101273479     Medline TA:  Vasc Health Risk Manag     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  249-56     Citation Subset:  IM    
Affiliation:
Dipartimento Cardiovascolare, Università di Bologna, Italy. giovanni.melandri@aosp.bo.it
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary
Blood Transfusion
Drug Administration Schedule
Drug Therapy, Combination
Emergency Medical Services
Fibrinolytic Agents / administration & dosage,  adverse effects,  therapeutic use*
Hemorrhage / chemically induced,  prevention & control
Humans
Injections, Intravenous
Myocardial Infarction / drug therapy*
Thrombolytic Therapy*
Tissue Plasminogen Activator / administration & dosage,  adverse effects,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/tenecteplase; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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