Abstract Details

Title 12 versus 24 h Bed Rest After Acute Ischemic Stroke Thrombolysis: A 14-year Retrospective Cohort Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-013

Objective

We compared favorable discharge outcomes (defined as home, inpatient rehabilitation facility, or acute rehabilitation) and secondary outcome measures including incidence of pneumonia in acute ischemic stroke (AIS) patients treated with thrombolysis who followed a ≥12-hour versus ≥24-hour bed rest protocol.

Background

The practice of a minimum of 24 hour bed rest following thrombolytic therapy for AIS is a widely adopted standard of care among hospitals, yet its benefit over earlier mobilization is unclear.

Design/Methods Consecutive adult AIS patients at a single comprehensive stroke center who received IV thrombolysis from January 3, 2010, until December 30, 2024, identified from a local ischemic stroke registry, were included. Standard 24-hour bed rest (the protocol prior to April 8, 2020) was retrospectively compared with the center's current practice- 12-hour bed rest.

Results 1321 patients were identified (466 in the ≥12-hour group, 855 in the ≥24-hour group). There was no between-group difference in the median (IQR) length of stay (3.3 days vs. 3.4 days, Wilcoxon p=0.36) or unplanned readmission rate at 30 days (8.7% vs. 10.5%, LR χ² p-value=0.40) and 90 days (15.6% vs. 16.1%, LR χ² p-value=0.86). There was no difference in the frequency of good outcomes (mRS=0-2) by 90 days between the groups (61.5% vs. 55.7%, χ² p-value =0.42). Rates of pneumonia (both in unadjusted and adjusted analyzes) were lower in the 12-hour group (unadjusted: 1.1% vs. 3.4%, LR χ² p=0.006; adjusted OR= 0.53 (95% CI= 0.20: 1.44). There was a significant difference in favorable discharge outcome in the ≥12-hour group compared with the ≥24-hour group both in unadjusted z-test of proportions (80.0% vs. 69.0%, Likelihood Ratio χ² p<0.001) and in multivariable logistic regression analysis (adjusted OR=1.34; 95% CI=1.01:1.86) favoring the 12-hour group.

Conclusions Compared with ≥24-hour bed rest, ≥12-hour bed rest after AIS thrombolysis was associated with more favorable discharge outcomes and reduced occurrence of pneumonia.

Authors/Disclosures
Isabella OShea PRESENTER	Ms. OShea has nothing to disclose.
Muhammed Gunduz, MD (University of Massachusetts Medical School)	Dr. Gunduz has nothing to disclose.
Nils Henninger, MD, PhD, FANA, FWSO (UMass Memorial Medical Center)	Dr. Henninger has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Henninger has stock in United Health. Dr. Henninger has stock in Novo Nordisk. Dr. Henninger has stock in Elli Lilly. Dr. Henninger has stock in Kenvue. Dr. Henninger has stock in Voyager. Dr. Henninger has stock in Alnylam. Dr. Henninger has stock in Entrada. The institution of Dr. Henninger has received research support from NIH. Dr. Henninger has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Verge Genomics.
Majaz Moonis, MD, FAHA, FAAN (University of Massachusetts, Department of Neurology)	Dr. Moonis has nothing to disclose.
Raphael A. Carandang, MD, FAAN (University of Massachusetts Medical School/UMASS Memorial Medical Group)	Dr. Carandang has nothing to disclose.
Rakhee Lalla, DO	Dr. Lalla has received personal compensation in the range of $0-$499 for serving as a Consultant for Women's health initiative .
Danison Emmerson, MD (UMass Memorial Medical Center)	Dr. Emmerson has nothing to disclose.
Muhammad Ramzan, MD (UMMH)	No disclosure on file
Thomas Ford, MD (University of Massachusetts Medical Center)	Dr. Ford has nothing to disclose.
Annie Ferris, MD (UMass Memorial Neurology Dept.)	An immediate family member of Dr. Ferris has received personal compensation for serving as an employee of Immanuel Lutheran Church.
Adalia H. Jun-O'Connell, MD, MBA, FAAN (MRMC)	Dr. Jun-O'Connell has received personal compensation in the range of $5,000-$9,999 for serving as a member with Women's Health Initiative.
Kayla Overly, PA	Mrs. Overly has nothing to disclose.
Bruce Barton (UMass Memorial Medical Center)	No disclosure on file
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.

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