No existe una lista de contraindicaciones definitiva y universalmente aceptada, y al parecer existe una tendencia a ser simplificada en los últimos años. Adviértase que las referencias difieren en algunos puntos. 

Absolutas (4, 7, 8, 10)

• Hemorragia intracraneal previa o accidente cerebrovascular de origen desconocido en cualquier momento

• Accidente cerebrovascular isquémico en los 6 últimos meses

• Daño del sistema nervioso central o neoplasias o malformación arteriovenosa

• Trauma mayor/cirugía/lesión craneal importante y reciente (en el mes anterior)

• Hemorragia gastrointestinal en el último mes

• Trastorno hemorrágico conocido (excluida la menstruación)

• Disección aórtica

• Punciones no compresibles en las últimas 24 horas (ej. Biopsia hepática, punción lumbar)

• Hemorragia interna activa

Relativas (4, 7, 8, 10)

• Accidente isquémico transitorio en los últimos 6 meses

• Tratamiento anticoagulante oral

• Embarazo o primera semana postparto

• Hipertensión refractaria (PAS >180 o PAD >110 mmHg)

• Enfermedad hepática avanzada

• Endocarditis infecciosa

• Úlcera péptica activa

• Reanimación prolongada o traumática

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9. EXTEND-IA TNK Part 2 - Campbell BC, Mitchell PJ, Churilov L, et al. Determining the optimal dose of tenecteplase before endovascular therapy for ischemic stroke (EXTEND-IA TNK Part 2): A multicenter, randomized, controlled study. Int J Stroke. 2020;15(5):567-572. doi:10.1177/1747493019879652
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10. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi:10.1093/eurheartj/ehz405
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11. Putaala J, Saver JL, Nour M, Kleindorfer D, McDermott M, Kaste M. Should Tenecteplase be Given in Clinical Practice for Acute Ischemic Stroke Thrombolysis?. Stroke. 2021;52(9):3075-3080. doi:10.1161/STROKEAHA.121.034244
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12. NOR-TEST 2, Part A - Kvistad CE, Næss H, Helleberg BH, et al. Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022;21(6):511-519. doi:10.1016/S1474-4422(22)00124-7
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13. Alamowitch S, Turc G, Palaiodimou L, et al. European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke. Eur Stroke J. 2023;8(1):8-54. doi:10.1177/23969873221150022
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