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Abstract Details

Early mobilization after 12 hours post thrombolysis is feasible and safe in minor stroke patients
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (5:30 PM-6:30 PM)
3-039

We sought to compare outcomes and in-hospital complications of 12- and 24-hour bed rest protocols following thrombolysis in minor stroke patients.

Current guidelines recommend 24 hours of hospital bed rest after thrombolysis for acute ischemic stroke. There is no scientific evidence for these guidelines and leads to unnecessary immobilization 

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.

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). 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. Time to mobilization was significantly different between the two groups (24 hour group-2043.2 ± 680.1 minutes; 12 hour group-1144.5 ± 539.0) (p<0.001). 
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.
Authors/Disclosures
Muhib Khan, MD, FAAN (Mayo Clinic)
PRESENTER 		The institution of Dr. Khan has received research support from Mayo Clinic 好色先生 Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
No disclosure on file
No disclosure on file
No disclosure on file
Cuyler Huffman No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Bassel Raad, MD (Advent Health) No disclosure on file
Joseph Zachariah, DO (Spectrum Health) Dr. Zachariah has nothing to disclose.
Elysia James, MD (University of Toledo) Dr. James has nothing to disclose.
No disclosure on file
No disclosure on file
Tamer Abdelhak, MD (Albany Medical College) Dr. Abdelhak has nothing to disclose.
Brian Silver, MD, FAAN (UMass Memorial Medical Center) Dr. Silver has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Various legal firms. Dr. Silver has received intellectual property interests from a discovery or technology relating to health care. Dr. Silver has received publishing royalties from a publication relating to health care. Dr. Silver has received publishing royalties from a publication relating to health care. Dr. Silver has received publishing royalties from a publication relating to health care. Dr. Silver has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Women's Health Initiative. Dr. Silver has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Best Doctors, Inc./Teladoc, Inc.. Dr. Silver has a non-compensated relationship as a Consultant with ABPN that is relevant to AAN interests or activities. Dr. Silver has a non-compensated relationship as a Member, Regional Board of Directors with American Heart Association that is relevant to AAN interests or activities.