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a modified form of human tissue plasminogen activator produced by recombinant DNA technology; used as a thrombolytic agent in the treatment of myocardial infarction, administered intravenously.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Metalyse, TNKase

Pharmacologic class: Tissue plasminogen activator

Therapeutic class: Thrombolytic enzyme

Pregnancy risk category C


Binds to fibrin and converts plasminogen to plasmin, which breaks down fibrin clots and lyses thrombi and emboli. Causes systemic fibrinolysis.


Powder for injection: 50 mg/vial with 10-ml syringe and TwinPak Dual Cannula Device and 10-ml vial of sterile water for injection

Indications and dosages

To reduce mortality associated with acute myocardial infarction

Adults weighing 90 kg (198 lb) or more: 50 mg I.V. bolus given over 5 seconds

Adults weighing 80 kg to 89 kg (176 to 197 lb): 45 mg I.V. bolus given over 5 seconds

Adults weighing 70 kg to 79 kg (154 to 175 lb): 40 mg I.V. bolus given over 5 seconds

Adults weighing 60 to 69 kg (132 to 153 lb): 35 mg I.V. bolus given over 5 seconds

Adults weighing less than 60 kg (132 lb): 30 mg I.V. bolus given over 5 seconds


• Hypersensitivity to drug or other tissue plasminogen activators

• Active internal bleeding

• Bleeding diathesis

• Recent intracranial or intraspinal surgery or trauma

• Severe uncontrolled hypertension

• Intracranial neoplasm

• Arteriovenous malformation or aneurysm

• History of cerebrovascular accident (CVA)


Use cautiously in:

• previous puncture of noncompressible vessels, organ biopsy, hypertension, acute pericarditis, high risk of left ventricular thrombosis, subacute bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, septic thrombophlebitis, obstetric delivery

• patients taking warfarin concurrently

• patients older than age 75

• pregnant or breastfeeding patients.


• Reconstitute by mixing contents of prefilled syringe with 10 ml of sterile water for injection. Swirl gently; don't shake. Draw up prescribed dosage from vial, then discard remainder. Give I.V. over 5 seconds through designated line.

Don't deliver in same I.V. line with dextrose solutions. Flush I.V. line with normal saline solution before giving drug if patient has been receiving dextrose.

Give with heparin if ordered, but not through same I.V. line.

Adverse reactions

CNS: intracranial hemorrhage, CVA

CV: hypotension, arrhythmia, myocardial rupture, myocardial reinfarction, cardiogenic shock, atrioventricular block, cardiac arrest, cardiac tamponade, heart failure, pericarditis, pericardial effusion, mitral regurgitation, thrombosis, embolism, hemorrhage

EENT: epistaxis, minor pharyngeal bleeding

GI: nausea, vomiting, hemorrhage

GU: hematuria

Hematologic: anemia, bleeding tendency

Respiratory: respiratory depression, pulmonary edema, apnea

Skin: bleeding at puncture sites, hematoma


Drug-drug. Anticoagulants, aspirin, dipyridamole, indomethacin, phenylbutazone: increased bleeding risk

Drug-diagnostic tests. Coagulation tests: fibrinogen degradation in blood sample

Patient monitoring

Monitor ECG. Stay alert for reperfusion arrhythmias.

Monitor vital signs carefully. Watch for signs and symptoms of respiratory depression and reinfarction.

Evaluate all body systems closely for signs and symptoms of bleeding. If bleeding occurs, stop drug and give antiplatelet agents, as ordered.

• Monitor CBC and coagulation studies. However, know that drug may skew coagulation results.

Patient teaching

Inform patient that drug increases risk of bleeding. Advise him to immediately report signs and symptoms of bleeding.

• Teach patient safety measures to avoid bruising and bleeding.

• Tell patient he'll undergo regular blood tests during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


TNKase® Cardiology A single-bolus thrombolytic clinically similar to tPA Adverse effects Intracranial bleeding, stroke, major or minor bleeding, hematomas. See Thrombolytic, tPA.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
Metalyse is another drug used to treat strokes and heart attacks and is used as an alternative to alteplase.
According to Dr Alper, metalyse works similar to alteplase.
"There is no direct evidence on metalyse, however the drug works similar to alteplase," he told the GDN.
"The limited direct evidence comparing metalyse and alteplase is consistent, with metalyse being a little more safe and effective.
The physician administered 'Metalyse' in the drip to prevent any further blood clot inside his coronaries.