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An Advanced Lytic by Design

Genentech's goal in developing TNKase was to create a thrombolytic with refined clinical properties relative to wild-type recombinant tissue plasminogen activator (rt-PA). TNKase incorporates three targeted alterations, each of which contributes to the pharmacological improvements that are seen in TNKase relative to rt-PA. The process of designing TNKase began with a systematic effort to map critical features of the rt-PA molecule responsible for its clinical

properties.1 Using site-directed mutagenesis, researchers evaluated over 1,000 variants of rt-PA, allowing them to identify key structure-function relationships.2 Three targeted substitutions differentiate TNKase from the rt-PA molecule and contribute to the following pharmacological improvements:


Increased Fibrin Specificity1

TNKase has 14-fold greater fibrin selectivity in vitro than Activase® (the clinical significance of increased fibrin specificity has not been established)


Greater Resistance to Plasminogen Activator Inhibitor-1 (PAI-1)1

TNKase is 80-fold more resistant to PAI-1 in vitro relative to Activase. PAI-1 is a natural inhibitor to fibrinolysis that can disrupt plasminogen activation


Long Plasma Half-Life2

The half-life of TNKase is 5 to 7 times that of Activase in vivo, allowing it to be delivered in one single bolus over 5 seconds

With the exception of TNKase, other lytic agents must be administered either as infusions or as multiple injections

Indication
For use in mortality reduction associated with acute myocardial infarction (AMI). Treatment should be initiated as soon as possible after the onset of AMI symptoms.

Important Safety Information
TNKase therapy in patients with acute myocardial infarction is contraindicated in the following certain situations (eg, active internal bleeding, history of cerebrovascular accident, known bleeding diathesis, severe uncontrolled hypertension) because of an increased risk of bleeding [See CONTRAINDICATIONS in full prescribing information].

The most common complication encountered during TNKase therapy is bleeding. Should serious bleeding (not controlled by local pressure) occur, any concomitant heparin or antiplatelet agents should be discontinued immediately.

In certain conditions (eg, recent major surgery, cerebrovascular disease, hypertension) the risk of TNKase therapy may be increased and should be weighed against the anticipated benefits. [See WARNINGS in full prescribing information].

Cholesterol embolism has been reported rarely in patients treated with all types of thrombolytic agents; the true incidence is unknown.

Coronary thrombolysis may result in arrhythmias associated with reperfusion. It is recommended that anti-arrhythmic therapy for bradycardia and/or ventricular irritability be available when TNKase is administered.

Please see full Prescribing Information for additional important safety information.


References:
1.  Bennett WF, Paoni NF, Keyt BA, et al. High resolution analysis of functional determinants on human tissue-type plasminogen activator. J Biol Chem. 1991;266:5191-5201.
2. Cannon CP, McCabe CH, Gibson CM, et al. TNK-tissue plasminogen activator in acute myocardial infarction: results of the Thrombolysis Myocardial Infarction (TIMI) 10A dose-ranging trial. Circulation. 1997;95:351-356.





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Please see TNKase full Prescribing Information. TNKase® (Tenecteplase). Activase® (Alteplase, recombinant).

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