Abstract WP485: Early Mobilization After 12 Hours Post Thrombolysis is Feasible and Safe in Minor Stroke Patients

Abstract

Background: Current guidelines recommend 24 hours of hospital bed rest after thrombolysis for acute ischemic stroke. We sought to compare outcomes and in-hospital complications of 12- and 24-hour bed rest protocols following thrombolysis in minor stroke patients. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke with initial National Institute of Health Stroke Scale (NIHSS) 0-6 who received intravenous thrombolysis only from 1/1/2017 until 4/30/2018 were included. Standard practice bed rest order for 24 hour protocol prior to 07/15/2017 was compared with 12 hour bed rest order protocol after that date. Primary outcome was length of stay. Secondary outcome measures included symptomatic intracerebral hemorrhage (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: 77 patients were identified, 36 patients in the 24-hour protocol and 41 in 12-hour bed rest protocol groups. There was no significant difference for length of stay in the 24-hour bed rest protocol (2.8 days) compared with the 12-hour bed rest protocol (2.3 days) (p=0.37) (Table). Compared with the 24-hour bed rest group, the rates of sICH (p=1.00), DVT (p=NS), PE (p=NS), pneumonia (p=1.00), favorable discharge disposition (p=0.69), 30 day readmission (p=0.80) and 90 day mRS 0-2 (p=0.36) were also not different between the groups (Table). Time to mobilization was significantly different between the two groups (p<0.001) (Table). Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with significantly earlier patient mobilization without any adverse outcomes. A randomized trial is needed to verify these findings.