12 versus 24 h Bed Rest After Acute Ischemic Stroke Thrombolysis: A 14-year Retrospective Cohort Study
Isabella OShea1, Muhammed Gunduz2, Nils Henninger3, Majaz Moonis4, Raphael Carandang5, Rakhee Lalla3, Danison Emmerson3, Muhammad Ramzan6, Thomas Ford7, Annie Ferris8, Adalia Jun-O'Connell9, Kayla Overly3, Bruce Barton3, Brian Silver3
1UMass Medical school, 2University of Massachusetts Medical School, 3UMass Memorial Medical Center, 4University of Massachusetts, Department of Neurology, 5University of Massachusetts Medical School/UMASS Memorial Medical Group, 6UMMH, 7University of Massachusetts Medical Center, 8UMass Memorial Neurology Dept., 9MRMC
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.
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