The edition · Cardiology
Brain bleeding after tenecteplase tracks blood pressure, age and dose
Pooled data from six trials and nearly 16,000 STEMI patients point to the risks you can still change before lysis, alongside drug-coated balloons for high bleeding risk and oral PCSK9 inhibitors.
The edition in brief
A pooled individual-patient analysis of six tenecteplase trials (15,954 STEMI patients, 169 intracranial haemorrhages) found risk rose about 2% for each 1 mmHg of systolic pressure above 110 mmHg and climbed steeply above 160 mmHg. Female sex (adjusted OR 1.49) and lower body weight (OR 1.16 per 5 kg less) also raised risk, and the effect of age grew with dose: about 1% per year at 30 mg against nearly 7% per year at 50 mg. Lowering blood pressure before lysis and reducing the dose in older patients are the modifiable levers. In the high-bleeding-risk subgroup of SELUTION DeNovo (522 patients), a sirolimus-eluting balloon strategy had numerically lower target vessel failure and bleeding than drug-eluting stents at one year, and more patients came off all antiplatelets, but the subgroup was not powered and every confidence interval crossed zero. A network meta-analysis of five trials (4,227 participants) found oral PCSK9 inhibitors lowered LDL cholesterol by up to about 60 percentage points against placebo, with no short-term safety signal, low certainty and no outcome data. The FDA lists an ongoing Class II recall of one premixed intravenous amiodarone product for manufacturing-practice deviations. The pearl: check potassium, magnesium and the QT interval before and during intravenous amiodarone.
Sirolimus-eluting balloons in high bleeding risk PCI: fewer events, not yet proven
Keep drug-eluting stents with short antiplatelet therapy as the default for high bleeding risk; treat balloon-only PCI as promising, not proven.
Oral PCSK9 inhibitors cut LDL cholesterol by up to 60 points against placebo
Continue to intensify with statin and ezetimibe first; oral PCSK9 inhibitors are an LDL-lowering result awaiting outcome trials.
FDA lists a Class II recall of one premixed intravenous amiodarone product
Ask your pharmacy to check stock of imported premixed intravenous amiodarone against the FDA recall; amiodarone itself is unaffected.
Before intravenous amiodarone: potassium, magnesium, QT
Correct potassium and magnesium and check the QT interval before and during intravenous amiodarone.
Intracranial bleeding after tenecteplase rises with blood pressure, age and dose
Before tenecteplase for STEMI, check and consider lowering a raised systolic pressure, and consider a reduced dose in older patients.
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