HMH Maestro

Clinical Alerts

Tenecteplase in Acute Ischemic Stroke (AIS)

All LocationsEmergency MedicineNeurology

 Alteplase (tPA) will no longer be used for AIS, but will be available for other indications.

WHY THE SWITCH? 

TENECTEPLASE AIS DOSING: 

WHO CAN ORDER? WHERE? 

ORDERING TENECTEPLASE IN EPIC: 

1. Open patient’s profile 
2. Click Manage Orders tab and type in search bar “tenecteplase” 
3. Click Thrombolytic Therapy for Ischemic Stroke 
4. Click Tenecteplase and check appropriate weight-based dosing 

IMPORTANT NOTES: 

TENECTEPLASE REVERSAL GUIDELINES: 

For thrombolytic-related symptomatic intracranial hemorrhage in patients who have received tenecteplase in the previous 24 hours:

References: 

1. Campbell BCV, et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med. 2018;378(17):1573-1582.
2. Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2012;366(12):1099-1107. 
3. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [published correction appears in Stroke. 2019 Dec;50(12):e440-e441]. Stroke. 2019;50(12):e344-e418.