TNK-tPA does not increase intracranial hemorrhage risk but is associated with less non-cerebral bleeding compared to rt-PA, particularly in high-risk patients.
Does TNK-tPA reduce bleeding events compared to rt-PA in patients receiving fibrinolytic therapy?
TNK-tPA offers a safer bleeding profile regarding non-cerebral bleeding compared to rt-PA, particularly in high-risk patients.
Tasa de eventos absoluta: 0% vs 0%
BACKGROUND: Fibrinolytic therapy increases the risk of bleeding events. TNK-tPA (tenecteplase) is a variant of rt-PA with greater fibrin specificity and reduced plasma clearance that can be given as a single bolus. We compared the incidence and predictors of bleeding events after treatment with TNK-tPA and rt-PA. METHODS AND RESULTS: In the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT)-2 trial, 16 949 patients with acute myocardial infarction were randomly assigned a single weight-adjusted bolus of TNK-tPA or a 90-min infusion of rt-PA. A total of 4.66% of patients in the TNK-tPA group experienced major non-cerebral bleeding, in comparison with 5.94% in the rt-PA group (P=0.0002). This lower rate was associated with a significant reduction in the need for blood transfusion (4.25% vs 5.49%, P=0.0003) and was consistent across subgroups. Independent risk factors for major bleeding were older age, female gender, lower body weight, enrolment in the U.S.A. and a diastolic blood pressure 75 years and body weight 75 years of age who weighed <67 kg tended to have lower rates of intracranial haemorrhage when treated with TNK-tPA (3/264, 1.14% vs 8/265, 3.02%). CONCLUSIONS: The increased fibrin specificity and single bolus administration of TNK-tPA do not increase the risk of intracranial haemorrhage but are associated with less non-cerebral bleeding, especially amongst high-risk patients.
“There is less incidence of nonintracranial bleeding with TNKase than t-PA. This is likely due to its greater degree of fibrin-specificity. That is, it is much more active at the clot itself in the coronary artery and causes less disturbance of the coagulation system.”
Frans Van de Werf (Sat,) reported a other. TNK-tPA does not increase intracranial hemorrhage risk but is associated with less non-cerebral bleeding compared to rt-PA, particularly in high-risk patients.