Safety of the weight-adjusted dosing regimen of tenecteplase in the ASSENT-Trial

The results of the ASsessment of Safety and Efficacy of a New Thrombolytic agent (ASSENT-2) trial revealed that tenecteplase (TNK) is equivalent to tissue plasminogen activator (t-PA) for treating myocardial infarction. Because careful consideration of safety is important with all agents, including the newer bolus therapies, and across a range of doses, this study evaluated the safety of TNK compared with t-PA across a range of weight and dose categories. The 5 doses of TNK ranged from 30 to 50 mg and were adjusted for estimated weight. Rates of death and intracranial hemorrhage were determined among patients receiving TNK and t-PA in ASSENT-2, stratified by categories of estimated weight corresponding to each TNK dose. Respective rates of death with TNK versus t-PA were not significantly different in any estimated weight category: <60 kg (12.54% vs 11.46%), 60 to 69 kg (8.22% vs 8.97%), 70 to 79 kg (5.57% vs 5.48%), 80 to 89 kg (4.66% vs 5.36%), and ≥90 kg (4.91% vs 3.96%, all p ≥0.26). Respective rates of intracranial hemorrhage were also not significantly different: <60 kg (2.20% vs 2.29%), 60 to 69 kg (0.97% vs 1.33%), 70 to 79 kg (1.15% vs 1.10%), 80 to 89 kg (0.73% vs 0.49%), and ≥90 kg (0.47% vs 0.47%, all p ≥0.33). Adjustment for small baseline differences in this randomized sample did not change the results. Thus, across the range of estimated weight categories corresponding to each TNK dose, TNK is as safe and effective as t-PA.