Safety and Feasibility of a Fast-Track Monitoring Protocol for Patients Treated with Intravenous Thrombolytic Therapy

Abstract

Introduction:<break><break>Our health care systems continue to face significant strain due to chronically taxed intensive care resources. A subgroup of post-thrombolytic stroke patients may not require prolonged intensive monitoring, alleviating some burden. Here we describe the safety, feasibility, and utility of a Fast-Track Protocol (FTP) for early de-escalation of high-acuity monitoring.<break><break> <break><break>Methods:<break><break>We compared a prospective cohort of FTP patients at our stroke centers from April 2020 February 2022 to a similar retrospective cohort. Those on presentation with NIHSS < 10 and without large vessel occlusion or flow-limiting stenosis, intravenous anti-hypertensive use, and any hemodynamic or respiratory concerns were eligible. Primary outcomes included early neurologic deterioration, defined as worsening of NIHSS 4-points at 24 hours, parenchymal hemorrhage, and symptomatic intracranial hemorrhage.<break><break> <break><break>Results:<break><break>Of 574 thrombolysis patients, 119 (21%) were eligible for FTP. One hundred (88%) were included for analysis. The median IQR hospitalization was 2.0 1.6 days. None of the four patients with early neurologic deterioration were due to hemorrhage. No symptomatic intracranial hemorrhages occurred, and no FTP patients were transferred back to the ICU. Median IQR 90-day modified Rankin scale was 1 1.<break><break> <break><break>Discussion:<break><break>FTP is a safe and feasible strategy to triage ICU patients and decrease unnecessary ICU monitoring. This is important in a post-pandemic era as ICU resources continue to fluctuate. Future studies are needed to establish the optimal level of monitoring in post thrombolytic patients.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The study received no funding.

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Data Availability

Data used to prepare this manuscript may be made available upon reasonable request.

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