Off Label Use of Tenecteplase in the Management of High-Risk Pulmonary Embolism

Abstract

Background: Pulmonary embolism (PE) is a common multifactorial disease, but high-risk PE s a life-threatening condition associated with high mortality and morbidity and a heavy prognostic burden. Systemic thrombolysis is the first-line treatment approach for severe high-risk PE, but only few agents are indicated for use by international guidelines. Tenecteplase, a thrombolytic agent, is proven to reduce mortality and right ventricle dysfunction in high-risk PE, but is not approved yet by major recommendations. Aim: We present a series of cases of high-risk PE treated with Tenecteplase, with satisfying hemodynamic and clinical outcomes. Our goal is to encourage the usage of Tenecteplase with secure safety and efficacy in situations of unavailability of guidelines-approved fibrinolytic agents. Cases : Patients were included from January 2022 to January 2024. We report 3 cases of patients with high-risk PE treated with Tenecteplase where rtPA and other second-generations agents were not available. Clinical, biological and imaging data were detailed for each case. Conclusion: Tenecteplase was effective in our patients, without bleeding complications, and should be suggested in settings of unavailability of first-line recommended agents.