Tenecteplase (TNK) in the Treatment of Intracerebral Hemorrhage (ICH)

Exclusion Criteria

• •Presence of infratentorial parenchymal bleeding.
• •Presence of a hemorrhage extending to the midbrain.
• •An unknown time of onset or the symptoms onset more than 24 hours prior to admission.
• •Pregnancy.
• •Inability to obtain written informed consent from subject or legal representative.
• •Sustained SBP \>180 mm Hg for six hours recorded closest to the time of drug administration.
• •Age \<18 and \>80 years.
• •Radiological evidence of arterio-venous malformation, aneurysm, amyloid angiopathy, Moyamoya disease, hemorrhagic conversion of an ischemic stroke, recurrent hemorrhage in the same location within the past 365 year or unstable mass as a source for the ICH.
• •Evidence of coagulopathy (international normalized ratio \>1.3; platelet count \<100 ,000 or platelet dysfunction P2Y-12 \>250) or known clotting disorder.
• •Bilateral fixed, dilated pupils indicating irreversible impaired brain stem function with GCS ≤4.
• •Patients with severe ICH and IVH who require an external ventricular drain (EVD) placement for cerebrospinal fluid (CSF) diversion or separate intraventricular thrombolysis.
• •Inability to maintain INR less than 1.3.
• •Use of anticoagulants prior to symptom onset and subjects requiring long-term anticoagulants (the reversal is permitted if the patient can tolerate the short-term risk of reversal).
• •Use of Dabigatran, Apixaban, and/or Rivaroxaban (or a similar medication from the similar medication class) prior to symptom onset.
• •Internal bleeding (GI, renal, respiratory etc).
• •Mechanical heart valve (Bioprosthetic heart valve is permitted).
• •Known risk for embolization, including history of left heart thrombus, mitral stenosis with atrial fibrillation, acute pericarditis, or subacute bacterial endocarditis (atrial fibrillation without mitral stenosis is permitted).
• •Allergy or sensitivity to TNKase.
• •Participation in a concurrent clinical trial.
• •Serious illness (advanced stage which can interfere with the outcome).
• •The patient is unstable and would not benefit from a surgical intervention.
• •GCS score of 3-4 and 15 (to ensure patient safety and study feasibility).
• •Historical mRS score of 2-6 (at admission).
• •Symptomatic tract hemorrhage or a tract hemorrhage more than 5 mm.