You should know risks of tenecteplase
Even though TNKase (tenecteplase, manufactured by Genentech, South San Francisco, CA), a new drug recently approved for the treatment of acute myocardial infarction (AMI), can be administered in only five seconds, you must remember you just administered a thrombolytic, cautions Paula Tanabe, RN, PhD, CCRN, advanced practice nurse for the ED at Northwestern Memorial Hospital in Chicago.
"You can’t just push the drug and forget the patient," she warns. "This is a critically ill patient and deserves the same assessment and monitoring that all AMI patients would routinely get."
Here are ways to reduce risks:
• Know contraindications.
The contraindications for TNKase are the same as for all thrombolytics and include the following, according to Tanabe:
— active internal bleeding;
— history of cerebrovascular accident;
— intracranial or intraspinal surgery or trauma within two months;
— intracranial neoplasm, arteriovenous malformation, or aneurysm;
— known bleeding diathesis (predisposition to hemorrhage);
— severe uncontrolled hypertension.
• Use heparin to reduce risk of bleeding.
As with all thrombolytics, there is a risk of bleeding, says Christopher B. Granger, MD, FACC, associate professor of medicine and director of the Cardiac Care Unit at Duke University Medical Center in Durham, NC.
"Appropriate use of heparin along with these drugs may help reduce risk of bleeding," he notes.
The 1999 American College of Cardiology/American Heart Association guidelines recommend a 60 units per kg bolus up to 4,000 units maximum, an initial infusion of 12 units per kg per hour up to a maximum of 1,000 units, and a target activated partial thromboplastin time of 50-70 seconds, says Granger. This is the recommended dosing for the heparin bolus and heparin infusion, he notes.1
Patients should be watched closely
• Watch patients closely.
These patients are at risk for reperfusion arrhythmias, and should be closely monitored, Tanabe says.
"It is also important to monitor for change in pain," she advises. "If symptoms do not improve over time, alternative reperfusion therapies will need to be pursued."
Reference
1. Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of acute myocardial infarction). J Am Coll Cardiol 1999; 34:890-911.
Information on dosage and administration, clinical studies, indications and usage for TNKase are available from the drug’s manufacturer. To obtain information, contact:
• Genentech, Medical Information, 1 DNA Way, South San Francisco, CA 94080-4990. Telephone: (800) 821-8590 or (650) 225-1000. Fax: (650) 225-1925. E-mail: [email protected]. Web: www.gene.com.
Genentech offers financial assistance programs for indigent patients. For consideration of eligibility for the Genentech assistance program, the patient must not be eligible for public or private insurance reimbursement and must meet income restrictions. Please direct requests for applications, forms, and other information to:
• Genentech, P.O. Box 2586, South San Francisco, CA 94083-2586. Telephone: (800) 879-4747. Fax: (650) 225-1366.
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