Background and Purpose Standard of care high‐intensity monitoring (HIM) following intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is resource‐intensive. We evaluated a targeted‐intensity monitoring (TIM) pathway for AIS patients considered low‐risk for post‐IVT complications. Methods We retrospectively reviewed all IVT cases between 1/2021‐10/2024 and identified all “low‐risk” patients (NIHSS ≤ 10, stable blood BP ≤ 180/105 mmHg, no large vessel occlusion, and preserved level of consciousness). Patients underwent conventional post‐IVT HIM (36 neurological assessments/vital sign measurements over 24 hours) until TIM (14 neurological assessments/vital sign measurements over 24 hours) pathway implementation on 3/16/22. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and early neurological deterioration (END). Secondary outcomes included hospital admission length of stay (LOS), ICU LOS and rates of hemorrhagic transformation and delirium. Between‐group comparisons were performed using the Mann‐Whitney U test, chi‐square test, Fisher's exact test, or generalized linear models. Results 49 post‐IVT patients received HIM and 52 patients received TIM. The cohort's median age was 68 years (IQR: 57‐79) and median NIHSS 4 (IQR: 2‐6). When comparing HIM versus TIM, there were no differences in END (0% vs 1.92%, p=1.00), sICH (0% vs 0%), hemorrhagic transformation (2.04% vs 0%, p=0.49 ), or delirium (6.12% vs 1.92%, p=0.28). Median hospital admission LOS was shorter with TIM (56.9 hours IQR 47.6‐94.9 vs 50.2 hours IQR 32.6‐96.1, p = 0.04 ). HIM median ICU LOS was 30.2 hours IQR: 22.9‐36.4 ; TIM patients were not admitted to the ICU. Conclusions TIM for low‐risk post‐IVT AIS patients demonstrated similar clinical outcomes to HIM. There were no cases of sICH in either group. Logistical advantages of TIM included bypassing routine ICU admission and decreased hospital admission LOS. image image
Hasan et al. (Sat,) studied this question.