What happened: A new stroke thrombolytic — tenecteplase — marketed as TNKase — has received FDA approval, marking the first such advancement in nearly 30 years. Unlike alteplase (tPA), which requires a lengthy infusion, TNKase can be administered as a 5-second IV bolus. Genentech will launch the drug in 25 mg vials, aimed at streamlining in-hospital acute stroke care.
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Highlights: Watch as Ed Bauter, MBA, MHL, NRP, FP-C, CCP-C; and Daniel Schwester, MICP, highlight the significance of this development, including:
- New formulation offers simpler administration. Unlike the traditional 60-minute infusion required for tPA, TNKase is given via a quick 5-second IV push, which could significantly reduce treatment delays in hospital settings.
- Limited impact for EMS in the near term. Although the administration method seems ideal for prehospital use, the complexities of stroke assessment — including CT imaging and neurologist evaluation — still limit EMS adoption.
- Mechanical thrombectomy remains the gold standard. With thrombectomy becoming more prevalent and effective, thrombolytics like TNKase are increasingly seen as transitional therapies, especially in urban areas with comprehensive stroke centers.
MORE | On-demand webinar — Time is brain: Stroke assessment and treatment guidelines
The path forward: While TNKase represents a pharmacological leap for in-hospital stroke treatment, EMS providers are unlikely to see its use in the field anytime soon. The need for advanced diagnostics and physician oversight means EMS teams will continue focusing on rapid stroke identification and transport. However, mobile stroke units and rural settings may provide early glimpses of future prehospital applications.
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