Dosing: Adult

STEMI: I.V.: The recommended total dose should not exceed 50 mg and is based on weight. Administer as a bolus over 5 seconds:

<60 kg: 30 mg dose

≥60 to <70 kg: 35 mg

≥70 to <80 kg: 40 mg

≥80 to <90 kg: 45 mg

≥90 kg: 50 mg

Note: All patients should receive 162-325 mg of chewable nonenteric coated aspirin as soon as possible and then daily. Administer concurrently with heparin 60 units/kg bolus (maximum: 4000 units) followed by continuous infusion of 12 units/kg/hour (maximum: 1000 units/hour) and adjust to aPTT target of 50-70 seconds (or 1.5-2 times the upper limit of control).

Combination regimen (unlabeled): Half-dose tenecteplase (15-25 mg based on weight) and abciximab 0.25 mg/kg bolus then 0.125 mcg/kg/minute (maximum: 10 mcg/minute) for 12 hours with heparin dosing as follows: Concurrent bolus of 40 units/kg (maximum: 3000 units), then 7 units/kg/hour (maximum: 800 units/hour) as continuous infusion. Adjust to aPTT target of 50-70 seconds.

Note: The 2004 ACC/AHA guidelines for the management of patients with STEMI suggests that abciximab and half-dose reteplase or tenecteplase may be considered for prevention of reinfarction in patients with anterior MI, who are <75 years of age and have no risk factors for bleeding. However, more recently the American College of Chest Physicians recommends against the combination of half-dose reteplase or tenecteplase and standard-dose abciximab (with low dose unfractionated heparin) in any patient with STEMI due to the lack of mortality benefit and the risk of major bleeding (Goodman, 2008).