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Single Bolus Dose Of Tenecteplase As Effective As Gold Standard For MI Treatment LONDON, ENGLAND -- Aug. 27, 1999 -- Reperfusion therapy to improve blood flow by breaking down the blood clot (fibrinolysis) is the first step in treatment after myocardial infarction. The current gold standard regimen is an initial dose in one administration (bolus) of 15 mg alteplase, followed by administration by infusion of 85mg over 90 min, during which the concentration of the drug is tapered. In this weeks' issue of The Lancet, the Assessment of the Safety and Efficacy of a New Thrombolytic Investigators from Belgium studied the use of another drug, tenecteplase, that can be given to patients in a single-bolus dose. The study enrolled 16,949 patients who had acute myocardial infarction within six hours before inclusion. They were randomly assigned alteplase front loaded infusion (100 mg) or single-bolus tenecteplase (30-50 mg, adjusted according to bodyweight), all with additional aspirin and heparin. The investigators compared all-cause mortality after 30 days in the two groups. Overall, tenecteplase and alteplase produced similar results in the two groups for the rates of death. Rates of other complications, such as bleeding complications and non-fatal stroke were similar but slightly lower in the tenecteplase group. The researchers said that the ease of administration with the single bolus might make early therapy out of hospital feasible. "Given the persistent delay in starting reperfusion therapy after symptom onset, prehospital thrombolysis with single-bolus tenecteplase seems to be an approach worth testing," the researchers write. Related Links: The Lancet. E-mail this page to a friend or colleague! To print, use this version