Thrombolysis is an established therapy for acute myocardial infarction in the UK. ST-elevation myocardial infarction almost always occurs owing to coronary atherosclerosis and coronary thrombosis which develops because of plaque disruption. Fibrinolytic agents act to dissolve the clot. Tenecteplase is a fibrinolytic agent that is given over ten seconds using the intravenous route. It is a fibrin-specific agent that has a prolonged plasma half-life and a high resistance to plasminogenactivator inhibitor type 1. These features mean that there is a potential decrease in the amount of time from the decision to thrombolyse and administration. In addition, because of the fibrin specificity and its resistance to plasminogen-activator inhibitor type 1, tenecteplase is more likely to restore a patent coronary artery.