The Tenecteplase Stroke Dose Calculator provides a weight-based dosing recommendation for adult patients with acute ischemic stroke. This tool is designed to support healthcare professionals by automating the calculation of the total drug dose (mg) and the corresponding volume to administer (mL), adhering to current clinical guidelines.

After entering a patient's weight, the calculator provides the following key outputs for administration:

• Total Tenecteplase Dose: The calculated dose in milligrams (mg) based on the 0.25 mg/kg regimen, up to a maximum of 25 mg.
• Volume to Administer: The volume in milliliters (mL) required for the single IV bolus injection. This is calculated assuming a standard reconstituted concentration of 5 mg/mL.
• Dose Capping Alert: A notification is displayed if the maximum dose of 25 mg is applied for a patient weighing 100 kg or more.

To ensure accurate and safe dose calculation, follow these steps:

• Enter Patient Weight: Input the patient's weight into the designated field. A recent, measured weight is preferred over an estimate.
• Select Units: Choose the correct weight unit, either kilograms (kg) or pounds (lbs). The tool will automatically convert lbs to kg for the calculation.
• Review Results: The calculated dose and volume will appear instantly. Always cross-verify the calculated values against institutional protocols and the patient's clinical status before administration.

The dosing regimen for tenecteplase in acute ischemic stroke is based on established clinical guidelines:

• Regimen: A single intravenous (IV) bolus of 0.25 mg/kg.
• Maximum Dose: The total dose is capped at 25 mg, regardless of how much the patient's weight exceeds 100 kg.
• Administration: The calculated volume should be administered as a single IV bolus over 5 seconds. Do not administer as an infusion.
• Reconstitution: Calculations assume the drug is reconstituted to a final concentration of 5 mg/mL (e.g., a 50 mg vial reconstituted with 10 mL of Sterile Water for Injection).

Tenecteplase is a single-dose therapy. "Switching" does not apply. However, management of subsequent antithrombotic therapy is critical:

• Antiplatelet Agents: Per AHA/ASA guidelines, administration of aspirin is typically delayed for 24 hours after thrombolytic therapy. A follow-up non-contrast head CT is usually required to rule out intracranial hemorrhage before starting antiplatelet agents.
• Anticoagulants: The initiation or resumption of therapeutic anticoagulation is also generally delayed for at least 24 hours post-thrombolysis and is guided by clinical evaluation and follow-up imaging.

As a single-bolus emergency medication, a "missed dose" is not applicable. However, administration errors must be carefully managed.

• Incorrect Dose: If an incorrect dose is administered (over or under), monitor the patient closely for signs of bleeding (especially intracranial hemorrhage) or lack of therapeutic effect. Immediately consult with a stroke specialist or neurologist.
• Extravasation: If the drug extravasates during injection, stop the administration immediately. Monitor the site for signs of tissue injury. Do not re-administer the dose without specialist consultation.

Tenecteplase is a potent thrombolytic with significant risks. It is contraindicated in patients with:

• Active internal bleeding.
• Recent (within 3 months) serious head trauma, intracranial or intraspinal surgery.
• Presence of intracranial conditions that increase bleeding risk (e.g., neoplasm, arteriovenous malformation, aneurysm).
• Current severe uncontrolled hypertension.
• Known bleeding diathesis.

The most common and serious adverse reaction is bleeding. Monitor all patients for signs of internal or external bleeding during and after treatment.

• Why is the maximum tenecteplase dose for stroke capped at 25 mg?
  The 25 mg cap is based on clinical trial data (e.g., EXTEND-IA TNK) which demonstrated the efficacy and relative safety of this dose. Higher doses may increase the risk of intracranial hemorrhage without providing additional benefit.
• What drug concentration is assumed for the volume calculation?
  The calculator assumes a final concentration of 5 mg/mL after reconstitution, which is standard practice (e.g., 50 mg vial with 10 mL diluent). Always verify with your pharmacy and product label.
• Can this calculator be used for pediatric patients?
  No. This tool is intended for adult patients with acute ischemic stroke. The safety and efficacy of tenecteplase in pediatric patients have not been established for this indication.
• What should I do if the patient's weight is an estimate?
  While a measured weight is ideal, if an estimate must be used, it is critical to use the best possible clinical judgment. The tool flags clinically improbable weights to prompt re-verification. Underdosing may reduce efficacy, while overdosing increases bleeding risk.
• How is the dose for tenecteplase different from alteplase in stroke?
  Tenecteplase (0.25 mg/kg, max 25 mg) is given as a single, rapid IV bolus. Alteplase (0.9 mg/kg, max 90 mg) is given as a 10% bolus over 1 minute, followed by a 90% infusion over 60 minutes.
• Why does the calculator flag weights below 30 kg or above 250 kg?
  These are soft warnings for weights that are uncommon in the adult population. It serves as a safety check to ensure the entered value is not a typo and is clinically plausible.
• Is this calculator suitable for other indications like myocardial infarction (MI)?
  No. The dosing for tenecteplase in ST-Elevation MI (STEMI) is different and based on weight tiers, not a direct mg/kg calculation. This tool is exclusively for acute ischemic stroke.
• Does the time from symptom onset affect the dose?
  No, the dose of 0.25 mg/kg remains the same. However, tenecteplase must be administered within the established therapeutic window (e.g., within 4.5 hours of symptom onset) for the patient to be eligible for treatment.

• Powers WJ, et al. 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. Link
• Genentech, Inc. TNKase® (Tenecteplase) Prescribing Information. U.S. Food and Drug Administration. Link
• Campbell BCV, et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med. 2018;378(17):1573-1582. Link
• The ASTRAL Investigators. An open label, randomised, parallel group, phase 3, non-inferiority trial of Tenecteplase versus Alteplase for thrombolysis in patients with acute ischaemic stroke within 4.5 hours of onset (A-STROKE). 2023. Link