Coronary thrombolysis may result in reperfusion arrhythmias. Cholesterol embolism rarely reported. For the following conditions risk of bleeding is higher with use of tenecteplase and should be weighed against benefits of therapy: recent (within 10 days) major surgery (e.g. CABG, obstetrical delivery, organ biopsy, previous puncture of noncompressible vessels), cerebrovascular disease, recent (within 10 days) GI or GU bleeding, recent trauma (within 10 days) including CPR, hypertension, high likelihood of left heart thrombus (e.g. mitral stenosis with atrial fibrillation), acute pericarditis, subacute bacterial endocarditis, hemostatic defects including those caused by severe renal or hepatic dysfunction, significant hepatic dysfunction, diabetic hemorrhagic retinopathy or other hemorrhagic ophthalmic conditions, septic thrombophlebitis or occluded AV cannula at seriously infected site, and/or any other condition in which bleeding constitutes a significant hazard or would be particularly difficult to manage due to location. Use with caution in patients receiving oral anticoagulants (increased risk of bleeding), and in recent administration of GP IIb/IIIa inhibitors. Concurrent heparin anticoagulation may contribute to bleeding. Avoid intramuscular injections. Caution with readministration of tenecteplase.