Tenecteplase (TNK)

TNK is a medication specifically designed to target and dissolve fibrin, a protein formed in a blood clot to impede the flow of blood to the brain. Stroke specialists have used this class of medication, called fibrinolytics, for more than 25 years. Research shows that TNK helps break up a blood clot just as well as other clot-busting medications, but does so possibly more safely and effectively.

TNK offers several advantages over other thrombolytic drugs, including faster and easier administration. Large clinical studies in acute ischemic stroke patients regularly show that giving a medication like TNK can increase a patient’s chances of returning to pre-stroke activities and reduces the chance of disability. This makes TNK an important option for treating patients who have had a stroke.

TNK works by targeting and dissolving fibrin, similarly to how tissue plasminogen activator (tPA) works. However, TNK has a higher affinity for fibrin than tPA, which may promote quicker and more effective opening of blood vessels.

It is important to consider the individual patient when choosing any clot-busting treatment. Some patients may not be eligible for TNK due to its time window, while others might be at a higher risk for bleeding.

As a clot-busting medication, bleeding is the primary side effect of TNK. If a patient is experiencing a stroke due to a blood vessel blockage, the stroke team will go through a series of questions to decide if TNK is safe to administer. Generally, a patient who is actively bleeding, has a bleeding disorder, is on blood thinners, recently had surgery or has experienced a past head bleed will not receive TNK. Although rare, this medication can cause bleeding in the brain, which can be a life-threatening side effect. 

Just like any medication, there is also a risk of an allergic reaction. The most common allergic reaction experienced by patients receiving TNK is swelling around the lips and tongue.

To watch the risks of this medication, every patient receiving TNK will be admitted to the hospital for monitoring and should expect to stay for at least 24 hours.

TNK is provided directly into the vein, or intravenously through an IV, typically found in the patient’s arm. While prior fibrinolytic therapy, like tPA, was administered intravenously over one hour, TNK is administered within a few seconds.

Most patients want to know if they will recover after a stroke and the use of TNK. While some patients show immediate improvements after receiving TNK, research most commonly assesses patient outcomes three months after a stroke. Studies have shown that patients who receive TNK are more likely to have little or no disabilities at the three-month time point compared to patients who did not receive the medication.

Additionally, many patients want to know their chances of experiencing a known risk or side effect. The stroke team will review the patient’s medical history and brain scans in detail to decrease any risk of bleeding from TNK. On average, six in every 100 patients treated with a clot-busting medication, such as TNK, will develop symptoms from bleeding into their brain. Treatments to reverse the effects of the medication may be administered to mitigate effects.

In addition to receiving TNK, patients with blockage of large arteries supplying the brain may also receive help from a treatment called a thrombectomy. This procedure physically removes the blood clot in the brain that is causing the stroke. This procedure is like a cardiac catheterization in which the blood vessels in the heart are opened during a heart attack. The UC Health Stroke Team, including neurointerventional specialists, will determine if a patient is eligible for this procedure.

After admission to the hospital, your care team will spend time finding the cause of the stroke, providing recovery and rehabilitation assessments, and determining how to prevent another stroke from occurring. Your providers may suggest rehabilitation care after your hospital stay and will work with you and your family to find the best option available.

Stroke care has advanced significantly over the last 30 years thanks to extensive research and innovation performed at UC Health and at other academic medical centers around the world. While in the emergency department or hospital, you may be approached about participating in one of the many studies being performed by our stroke team to improve stroke care further. Participation in these studies is optional.