Abstract WP448: Shorter Intensive Care Unit Stay (12 Hours) Post Thrombolysis is Safe and Reduces Length of Stay for Minor Stroke Patients

Abstract

Background and Purpose: Acute Stroke Patients treated with intravenous tissue-type plasminogen activator (tPA) require intensive care unit (ICU) monitoring for 24 hours post-treatment due to risk of symptomatic intracranial hemorrhage (sICH). This is a costly and resource intensive practice. In this study, we evaluated the safety and efficacy of shorter ICU monitoring for minor stroke patients treated with tPA. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke that received tPA only and who had an initial National Institute of Health Stroke Scale (NIHSS) 0-5 between 1/1/2017 and 3/30/2019 were included. Stroke mimics and those who underwent thrombectomy were excluded. Standard practice 24 hour ICU stay prior to 05/15/2018 was compared with 12 hour ICU stay after that date. The primary outcome was length of stay. Secondary outcome measures included sICH, deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days, and modified rankin scale (mRS) at 90 days. Results: Of the 122 patients identified, 77 patients were in the 24-hour protocol and 45 were in 12-hour ICU stay protocol groups. There was significant difference in length of stay for the 24-hour ICU stay protocol (2.8 days) compared with the 12-hour ICU stay protocol (1.8 days) ( P <.001). Compared with the 24-hour ICU stay, the rates of sICH ( p = .65), DVT ( p = NS), PE ( p = NS), pneumonia ( p = 1.00), favorable discharge disposition ( p = .26), 30 day readmission ( p =0.06) and 90 day mRS 0-2 ( p = .37) were not different between the groups. Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with without any adverse outcomes. A randomized trial is needed to verify these findings.