"Tenecteplase--the best among the equals.".

Tenecteplase is a genetically engineered product of the Alteplase molecule. Mutations of Alteplase at three locations result in a more fibrin specific thrombolytic agent with a longer half life. Such properties would allow bolus administration, leading to faster reperfusion of occluded arteries. Tenecteplase is equivalent to front loaded Alteplase in terms of mortality and is the only bolus thrombolytic drug for which equivalence has been demonstrated. Tenecteplase seems more potent than Alteplase when symptoms duration is more than 4 hours. Moreover, Tenecteplase significantly reduces the rate of major bleeds and the need for blood transfusion. The efficacy of Tenecteplase may be further improved by reducing re-infarction rate by enoxaparin instead of unfractionated heparin. Several large scale Clinical trials of Tenecteplase in acute myocardial infarction (MI) has been done making this drug truly evidence based. Available randomized studies and international clinical registries reveal that pre hospital thrombolysis by Tenecteplase is as effective as primary angioplasty. In fact Tenecteplase is now included in many prehospital thrombolytic reperfusion protocols, such as the Vienna STEMI registry, The Mayoclinic STEMI protocol and the French FAST-MI registry. Tenecteplase with so many evidence based advantages is a fair option in acute MI patients in whom primary PCI can not be offered due to logistic reasons.