Date of Award

2024

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Bonnie Bowie

Readers

Chen-Chen Tu

Abstract

Objective: Stroke remains a significant public health concern, with ischemic strokes being the most common type, contributing to high mortality and disability rates. The standard thrombolytic therapy for acute ischemic stroke (AIS) is intravenous alteplase. Tenecteplase (TNK), a genetically modified tissue plasminogen activator, has become an alternative because it works well to treat myocardial infarction. This study compares TNK and alteplase in treating AIS patients, evaluating outcomes such as door-to-needle time (DTN) particular in CT result to needle puncture time, financial implications associated with shorter patient’s length of stay, NIHSS scores and the incidence of post-hemorrhagic events.

Method and Result: A retrospective chart review was conducted at a thrombectomy-capable stroke center in a community hospital in the Pacific Northwest (NW). The study involved 175 AIS patients treated with alteplase (n=82) or TNK (n=93) between March 2022 and December 2023. Data analysis revealed no significant differences in CT result to needle time (p=0.82), length of stay (p=0.61), or post-ICH rates (p=0.52) between the two groups. The bivariate statistics did not show significant differences in NIHSS scores on admission and discharge (alteplase vs. TNK: p = 0.84, p = 0.09). Moreover, patient demographics and prevalence of risk factors were similar, except for obstructive sleep apnea (p=0.013).

Conclusion: Although TNK demonstrated comparable safety and efficacy to alteplase, its potential cost savings due to lower medication expenses warrant consideration. While TNK may not offer significant advantages over alteplase in terms of clinical outcomes, its reduced cost and potential for faster administration may make it available alternative in resource-limited settings.

Further research is needed to explore the generalizability of these findings and assess the impact of thrombolytic choice on long-term patient outcomes and healthcare resource utilization.

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