Abstract WP319: Safety and Efficacy of Low-Intensity Monitoring Protocol (LIMP) Following IV Thrombolysis In a Community Setting

Introduction: The OPTIMISTmain trial demonstrated the feasibility of reduced intensity neuromonitoring in select patients treated with intravenous thrombolytics. Building on this evidence, we evaluated the safety and effectiveness of a Low-Intensity Monitoring Protocol (LIMP) in a community hospital setting. Methods: We retrospectively analyzed 61 patients who received IV thrombolysis and monitored under LIMP versus standard of care between August 2022 and April 2025. All patients received standard of care monitoring per current AHA guidelines for the first 12 hours. Patients were eligible for LIMP if they had a baseline NIHSS < 6 and did not have clinical deterioration or require IV antihypertensives within the first 12 hours. LIMP was initiated at 12 hours post thrombolysis and was characterized by reduced frequency vital sign assessments every 4 hours and NIHSS evaluations every 2 hours between 12 to 24 hours compared to hourly assessments in the standard of care group. Eligible patients were transferred to the telemetry stroke unit when beds were available; otherwise, they remained in the ICU but were monitored at the reduced frequency. Outcomes included NIHSS trends, clinical deterioration or safety concerns, length of stay (LOS), and modified Rankin Scale (mRS) at 90 days. Results: Of the 61 patients, 41 (67%) were managed under the LIMP protocol and 20 (33%) received standard care. No patients in either group experienced neurological worsening at 24 or 36 hours, or at discharge. There were no significant differences in LOS (LIMP: 2.77 ± 1.17 days vs. standard: 5.12 ± 5.19 days, p =0.2) or mRS at 90 days (LIMP: 0.59 ± 1.07 vs. standard: 1.00 ± 1.22, p =0.5). No complications were reported in either group. Conclusion: This study highlights that LIMP is a safe and effective alternative to standard monitoring in patients who receive IV thrombolysis for symptoms of mild to moderate stroke. Healthcare systems should consider incorporating LIMP allowing for more cost-effective resource utilization in community settings.