Table 4.

How to use TNKase in STEMI patients

Bolus intravenous injection of TNKase over 5–10 seconds
TNKase dose according to body weight (BW)
30 mg if BW <60.0 kg
35 mg if BW between 60.0 and 69.9 kg
40 mg if BW between 70.0 and 79.9 kg
45 mg if BW between 80.0 and 89.9 kg
50 mg if BW ≥90.0 kg
Adjunctive anti-platelet therapy
Aspirin: 160–325 mg, followed by 75–162 mg per day, indefinitely
Clopidogrel: 75 mg per day (for at least 28 days if no stenting, 1 month
if using a bare metal stent, 1 year if using a drug eluting stent)
Initial clopidogrel dose: 300 mg if age ≤75 or if a stent is implanted
Adjunctive unfractionated heparin
Intravenous bolus: 60 U per kg (maximum 4000 U)
Intravenous infusion: 12 U per kg per hour (maximum 1000 U per hour)
Target activated partial thromboplastin time: 1.5–2.0 control
Treatment duration: minimum 48 hours
Adjunctive enoxaparin (only if serum creatinine <2.5 mg/dL in men, <2.0 in women):
Less than 75 years old: Intravenous bolus of 30 mg
Less than 75 years old: Subcutaneous injection of 1 mg/kg every 12 hours
At least 75 years old: No intravenous bolus
At least 75 years old: Subcutaneous injection of 0.75 mg/kg every 12 hours
If the creatinine clearance is <30 mL/min: subcutaneous injection every 24 hours
Treatment duration: for the duration of index hospitalization, up to 8 days
For patients undergoing PCI after TNKase
If on unfractionated heparin: additional boluses as needed
If on enoxaparin: no further anticoagulant if <8 hours from the subcutaneous injection
If on enoxaparin: additional intravenous bolus of 0.3 mg/kg if 8–12 hours
after the subcutaneous injection