TNKalc
Tenecteplase Stroke Eligibility & Dose Calculator
A bedside rule-out and dosing aid for tenecteplase in acute ischemic stroke — split by how the patient qualifies: the standard clock-based window, or an imaging-confirmed tissue window. Based on: 2026 AHA/ASA Guideline for the Early Management of Acute Ischemic Stroke
Dose calculator — 0.25 mg/kg, max 25 mg
Enter a weight to calculate the single IV bolus.
Last known well ≤ 4.5 hours COR 1
Treat as fast as possible — a non-contrast CT to exclude hemorrhage is all the imaging that's required. Tenecteplase 0.25 mg/kg (max 25 mg) single IV bolus is recommended as an effective alternative to alteplase 0.9 mg/kg, regardless of NIHSS, as long as the deficit is disabling. Don't wait on CTA/CTP/MRI to start the clock-eligible patient.
Stretch goals (Target: Stroke Honor Roll): ≤45 min door-to-needle for 75% of patients, ≤30 min for 50%.
Unknown onset, wake-up, or LKW > 4.5 h COR 2a / 2b
A plain CT cannot select these patients. Automated perfusion imaging (CTP) or MRI DWI-FLAIR mismatch is required to confirm salvageable tissue (penumbra) before treating beyond the standard window — and once it's confirmed, treatment is still urgent.
The 4.5–24h LVO scenario is the more conditional recommendation (COR 2b) — trial evidence is mixed and it should be directed by a thrombolysis/stroke specialist.
Labs & baseline workup
- CBC, electrolytes, PT/INR, point-of-care glucose, pregnancy test if applicable
- Baseline ECG and troponin are recommended but should not delay IVT or EVT
- If platelet count, INR, or glucose are unknown with no reason to suspect abnormal values, treatment may proceed while results are pending
Blood pressure targets
- Before treatment: < 185/110 mmHg
- For 24h after treatment: < 180/105 mmHg
- Recheck 5 minutes after any reading > 185/110 mmHg; notify the team if it persists
Post-dose monitoring timeline
- Neuro checks + vitals: pre-bolus, then q15min ×2h, q30min ×6h, q1h ×16h, q4h ×48h
- NIHSS: pre/immediately post-bolus, then 30min, 60min, 3h, 6h, 12h, 24h, 72h, and with any neurologic change
- Call the team immediately for: NIHSS increase > 4 points, sudden severe headache with a BP spike, or any sign of bleeding
Antithrombotic hold & imaging
- No anticoagulants or antiplatelets for 24 hours after tenecteplase
- Repeat brain CT or MRI roughly 18–24h after treatment, or immediately for neurologic deterioration
Bleeding-precaution care
- Avoid IM injections, unnecessary arterial punctures, NG tubes, and indwelling catheters in the first 24h where possible
- Use compressible sites and apply pressure dressings if access is required
- Bed rest for 12 hours, then reassess
If also eligible for thrombectomy
- Give IV thrombolysis to eligible patients even when endovascular therapy is planned
- Proceed directly to mechanical thrombectomy without waiting to observe a clinical response to tenecteplase — delaying worsens outcomes
Last updated: 6/2026
Disclaimer: This reference is a qualitative synthesis intended for educational use. Practice patterns vary — confirm against your institution's order set and a stroke specialist before acting. This page is a quick-reference aid, not a substitute for clinical judgment. Nothing you enter or check here is saved, stored, or sent anywhere — refreshing or closing the page clears every box.
References: 2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke (Prabhakaran et al., Stroke, 2026) and current institutional thrombolytic protocols.
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