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Content Update: Tenecteplase (TNKase) Thrombolytic Treatment, December 2023 and September 2024
Information is provided in the section entitled Tenecteplase (TNKase) under Thrombolysis Background. Please also review current Tenecteplase dosing recommendations. Note that the dose of tenecteplase for stroke is different and lower than the dose for acute myocardial infarction.
Terminology: rtPA (recombinant tissue plasminogen activator) is a drug class that includes alteplase and tenecteplase. Early clinical work on thrombolytics used rtPA interchangeably with alteplase because it was the only agent available. Terminology has been harmonized wherever possible to distinguish tenecteplase and alteplase.
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INTRODUCTION AND EPIDEMIOLOGY
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In the United States, 795,000 people experience strokes annually (one stroke every 40 seconds and one death from stroke every 4 minutes).1 Of these events, 77% are primary strokes, whereas 23% represent recurrent strokes.1 In addition to the human costs, the financial implications of stroke are enormous—strokes accounted for an estimated $33.9 billion of total expenditures in the United States in 2012 to 2013.1 Despite these grim statistics, from 2004 to 2014, the age-adjusted stroke death rate fell 28.7%.1 With the growing use of stroke units, thrombolysis, mechanical retrieval, and the ever-expanding treatment time window, there is potential for improving patient outcomes.
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PATHOPHYSIOLOGY AND ANATOMY
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Stroke is generally defined as any disease process that interrupts blood flow to the brain. Injury is related to the loss of oxygen and glucose substrates necessary for high-energy phosphate production and the presence of mediators of secondary cellular injury. Subsequent factors, such as edema and mass effect, may exacerbate the initial insult.
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An understanding of the diagnosis and treatment of stroke begins with a working knowledge of the relevant vascular supply and neuroanatomy of the brain. The arterial supply to the brain is illustrated in Figures 167-1 and 167-2.
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The vascular supply is divided into anterior and posterior circulations. Clinical findings in stroke are determined by the location of the lesion(s) ...