Abstract Body: Introduction
Current guidelines recommend 24-hours of high-intensity monitoring (HIM) for acute ischemic stroke patients post-intravenous thrombolysis (IVT) due to risk of bleeding complications including symptomatic intracranial hemorrhage (sICH). We report the outcomes of a 12-hour targeted-intensity monitoring (TIM) pathway for low-risk post-IVT patients.
Methods
Post-IVT patients were considered low-risk if their NIHSS < 10, blood pressure < 180/105 without medical intervention, level of consciousness was preserved, and no high-risk vessel stenosis/occlusion was present. All patients meeting these criteria between Oct 2020-April 2024 were included in our study; those who presented prior to March 2022 utilized the conventional HIM pathway and those presented afterwards utilized the TIM pathway. In the TIM pathway neurological exams and vital sign assessments were conducted every 15 minutes for the first hour, every 1 hour for the next 3 hours, every 2 hours for the next 8 hours, and every 4 hours for the next 12 hours (14 total neurochecks/vital sign assessments over 24 hours compared to 36 neurochecks/vital sign assessments with HIM). Patients utilizing the TIM pathway were admitted to an intermediate care unit bypassing the ICU.
We examined the number of TIM patients who required transfer from IMC to the ICU and the duration of time in the ICU for HIM patients. Additionally, we compared the length of hospital admission, rate of sICH, 24-hour NIHSS scores, and 90-day mRS scores in matched post-IVT HIM and TIM patients.
Results
A total of 95 patients were included in the study: 47 HIM (median age 71 [IQR 56-75.5], median NIHSS 4) and 48 TIM (median age 65, [IQR 60-81.25], median NIHSS 4). There were no significant differences in age, presenting blood pressure, or NIHSS between the two groups. The mean length of ICU-stay for the HIM group was 32.8 hours. No patient in the TIM pathway required transfer to the ICU for a higher level of care. The median length of hospital stay for the HIM group was 49.8 hours [IQR: 43.8-83.3] and 49.6 hours [IQR: 32.6-99.7] for the TIM group (p=0.716). No sICH was noted in either group. Median discharge NIHSS = 1 for both groups (p=0.125) and 90-day mRS = 2 for both groups (p=0.599)
Conclusion
In our study, post-IVT TIM was feasible without safety concerns. Post-IVT TIM pathways may conserve healthcare resources and increase ICU bed availability. Further studies defining the optimal post-IVT TIM criteria are indicated.