Graduation Date

Fall 12-19-2025

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Bethany Lowndes, PhD

Second Advisor

Scott Campbell, PhD

Third Advisor

Daniel Murman, MD

Abstract

Ischemic stroke is highly prevalent and an important cause of morbidity, mortality, and long-term disability in the in the United States. The incidence and prevalence of stroke is expected to increase in the next few years due to several factors including aging of the U. S. population, improved treatment, and socioeconomic factors. In 1996, the FDA approved rtPA for the treatment of ischemic stroke patients. Patients had a greater likelihood of recovering successfully. However, rtPA has significant limitations, such as an elevated risk of intracranial hemorrhage, administration difficulties, and limited effectiveness. In March 2025, the FDA approved the use of TNK, a bioengineered rtPA, for treatment of acute ischemic stroke patients. The efficacy of TNK has been found to be non-inferior to rt-PA in recent randomized trials and evidence suggests that it is safe and effective and is associated with time saving benefits. This thesis utilized real-world data contained in a large de-identified EHR data warehouse to describe thrombolytic utilization in ischemic stroke and compare clinical outcomes. Since 2021, an exponential increase in TNK utilization was observed throughout the United States. Patients treated with IV TNK were more likely to be discharged home, have lower rates of intracranial hemorrhage, lower length of stay, and lower in-hospital mortality. This project suggests that switching to TNK is associated with improved clinical outcomes including lower in- hospital mortality, lower length of stay, and increased discharge home likelihood.

Comments

2025 Copyright, the authors

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