Tenecteplase
| Evidence Level: L5 | Predicted Indications: 7 |
Table of Contents
Tenecteplase: Congenital coronary artery anomaly
One-Sentence Summary
Tenecteplase is a fibrin-specific clot-dissolving drug (thrombolytic), originally used to treat acute myocardial infarction and coronary thrombosis. This is an anatomical subtype of an already-approved indication, so it is not true repurposing, and the evidence is indirect.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Congenital coronary artery anomaly |
| TxGNN Prediction Score | 0.9961 |
| Evidence Level | L5 |
| Canada Market Status | Marketed (marketed DINs: 1 of 1) |
| Number of DINs | 1 (marketed: 1) |
| Recommended Decision | Hold (the other predicted indications are discussed below) |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Based on known pharmacology, tenecteplase is a fibrin-specific tissue plasminogen activator. It converts plasminogen to plasmin on the fibrin surface, which breaks down the fibrin mesh of a clot and can reopen a blocked coronary artery.
Posterolateral myocardial infarction is an anatomical subtype of acute myocardial infarction, which is already an established indication. The mechanism therefore applies directly. Posteroinferior and septal infarction follow the same logic: a coronary clot blocks the artery that supplies that region of the heart muscle.
Because no trials or publications were found for these specific subtypes, the support rests on the parent indication (ST-elevation myocardial infarction, STEMI). This is better read as a classification refinement than as a new use.
Clinical Trial Evidence
Currently no related clinical trials registered for this predicted indication.
Literature Evidence
Currently no related literature available for posterolateral myocardial infarction.
Other predicted indications do have some literature, summarized below.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 23975441 | 2014 | Review | J Thromb Thrombolysis | Efficacy and safety of weight-adjusted tenecteplase in 30 patients with acute pulmonary embolism (not a heart-attack study) |
| 18183355 | 2009 | Case report | J Thromb Thrombolysis | Massive pulmonary embolism that mimicked septal MI on ECG and was treated with tenecteplase |
| 42220791 | 2026 | Case report | Cureus | Ventricular septal rupture after early pharmaco-invasive reperfusion with tenecteplase in anterior STEMI (a complication, not evidence of efficacy) |
Coronary stenosis (rank 5, score 0.9953, L3): the most relevant papers are below.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 31870492 | 2020 | Randomized feasibility study | Am J Cardiol | ICE-T-TIMI 49: low-dose intracoronary tenecteplase (4 mg) vs saline during primary PCI in 40 STEMI patients, assessing feasibility and safety |
| 16053952 | 2005 | Clinical study | J Am Coll Cardiol | CAPITAL AMI: tenecteplase-facilitated angioplasty vs tenecteplase alone in high-risk STEMI |
| 16139127 | 2005 | Cohort | J Am Coll Cardiol | Intracoronary fibrin-specific thrombolytic infusion before PCI for chronic total occlusion |
| 17102829 | 2006 | Cohort/Pilot | Can J Cardiol | TRANSFER-AMI pilot: urgent PCI transfer after thrombolysis for STEMI |
| 25733729 | 2016 | Case report | Hum Exp Toxicol | Thrombolysis for inferolateral MI after carbon monoxide poisoning |
Study designs were inferred from truncated titles and abstracts, so the classifications are provisional.
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02244826 | TNKASE | Not listed | Not listed |
Safety Considerations
Drug Interactions: The interaction screening returned 100 interacting drugs. The entries reviewed include the following.
- Major: deferasirox, ibritumomab tiuxetan, tositumomab (including I-131), abciximab, acalabrutinib, apixaban, avapritinib, betrixaban. Most of these raise bleeding risk when combined with a thrombolytic.
- Moderate: acetylsalicylic acid, ketorolac (including ophthalmic), ibuprofen, topical diclofenac, celecoxib, aminocaproic acid, omega-3 fatty acids, fenfluramine, dexfenfluramine, sibutramine.
Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale:
- Posteroinferior and septal infarction are in the same position (L4). Coronary stenosis has some supportive intracoronary literature (L3), but it supports clot burden rather than treatment of fixed narrowing.
- The remaining predictions are not credible. Congenital coronary anomaly, chromosome 16 partial deletion, beta-thalassemia, glucophosphate isomerase deficiency hemolytic anemia, hereditary pyropoikilocytosis and pyruvate kinase deficiency have no plausible thrombolytic mechanism, and the scores come from the TxGNN model (deep learning) and may reflect similarities the model learned between related diseases, not biological evidence. They should be held (L5).
To proceed, the following is needed:
- Health Canada package insert warnings, contraindications and approved indication text (currently missing and blocking safety screening)
- Mechanism of action data from DrugBank
- Confirmation of whether the existing STEMI label already covers MI by infarct location, which would make a separate indication unnecessary
- For coronary stenosis, review of the intracoronary tenecteplase studies as a possible off-label or procedural research question
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.