Indications and contraindications

Contraindications

Tenecteplase (TNK-tPA, Metalyse^®) is contraindicated in the following situations because thrombolytic therapy is associated with a higher risk of bleeding:¹

• Significant bleeding disorder either at present or within the past 6 months
• Patients with current concomitant oral anticoagulant therapy (INR > 1.3)
• Any history of central nervous system damage (i.e. neoplasm, aneurysm, intracranial or spinal surgery)
• Known haemorrhagic diathesis
• Severe uncontrolled hypertension
• Major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2 months
• (this includes any trauma associated with the current AMI)
• Recent trauma to the head or cranium
• Prolonged cardiopulmonary resuscitation (> 2 minutes) within the past 2 weeks
• Acute pericarditis and/or subacute bacterial endocarditis
• Acute pancreatitis
• Severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis
• Active peptic ulceration
• Arterial aneurysm and known arterial/venous malformation
• Neoplasm with increased bleeding risk
• Any known history of haemorrhagic stroke or stroke of unknown origin
• Known history of ischaemic stroke or transient ischaemic attack in the preceding 6 months
• Dementia
• Hypersensitivity to the active substance tenecteplase and to any of the excipient