Symptomatic adverse events and bleeding complication rates post TPA drop drastically after 10-12 hrs. Current NINDS monitoring protocol should be further investigated and perhaps the 24 hours no touch period post TPA can be reduced to 12 hrs.

1995 NINDS clinical trial study used a protocol of no IV heparin,warfarin or antiplatelet drugs as well as to avoid NG tubes,arterial blood draws,IM injections,invasive lines or procedures during the first 24 hrs post TPA.It has been our experience that adherence to this protocol has led to instances of reluctance or refusal by physicians to perform important procedures including LPs,ABGs,NG,Foley tube,central line and arterial line insertions leading to additional patient morbidity.In addition,the patients are at bedrest and unable to start physical and occupational therapy during the 24 hour "no touch" period,potentially putting them at increased risk of DVTs and PE,as well as,delaying the start of important rehabilitation services. The rationale behind NINDS protocol was concern about increased bleeding risk post TPA, including sICH and systemic bleeding.However,the precise time interval between IV TPA administration and development of adverse events has never been determined.This post TPA monitoring protocol has not been modified since the original 1995 NINDS trial,hence rigorous evidence to support the practice of "no touch period" 24 hours post TPA is lacking.

Retrospective,observational study with extraction and analysis of clinical data obtained from review of EMR of patients who received IV TPA for acute ischemic stroke from 2014-2017 to investigate rate,type and time of adverse events as well as to determine complication rates upon intervention occurring within 24 hour "no touch" period post TPA.