Intracranial haemorrhage following tenecteplase fibrinolysis for acute myocardial infarction
Authors' conclusion
Dose reduction of TNK in older patients and SBP optimization before fibrinolytic administration represent modifiable strategies to potentially reduce ICH.
Study context
- Population
- ST-elevation myocardial infarction (STEMI) patients given weight-adjusted TNK (BP exclusion >180/110 mmHg) in ASSENT-2, ASSENT-3, ASSENT-3 PLUS, ASSENT-4 PCI, STREAM, STREAM-2
- Participants
- 15,954 participants · 6 RCTs
- Outcome
- Risk factors for ICH after TNK; clinical risk prediction tool
Methodological detailslogistic regression, nomogram for individual risk prediction
- Logistic regression
- Nomogram for individual risk prediction
Pooled result
As reported in the abstract
ICH and its risk factors
Adjusted odds ratio (95% CI)P value
SBP, per 1 mmHg increase above 110 mmHg2% relative increase in ICH risk; risk accelerated sharply beyond 160 mmHg
1.02(1.01–1.03)
P < 0.0001Female sex49% increased ICH risk
1.49(1.06–2.11)
P = 0.023Body weight, per 5 kg decrease16% increased odds of ICH
1.16(1.03–1.30)
P = 0.014Each row per its own increment, as printed
- Multivariable model (age, sex, systolic blood pressure (SBP), body weight, TNK dose, age-dose interaction) · good discrimination
- C index 0.718 (95% CI 0.68–0.76)
- Patients developing intracranial haemorrhage (ICH)
- 169
- Increase in ICH likelihood per year of age, 30 mg TNK
- 1%
- Increase in ICH likelihood per year of age, 50 mg TNK
- nearly 7%
Original publication
Intracranial haemorrhage following tenecteplase fibrinolysis for acute myocardial infarction. Eur Heart J. Published 21 September 2026. doi:10.
Summarised from the published abstract; every number is checked against it