Resource Allocation: Stable Patients Remain Stable 12-24 h Post-tPA

Area of Science:

• Neurology
• Critical Care Medicine
• Stroke Medicine

Background:

• Current stroke treatment protocols involve 24-hour monitoring for neurological deterioration.
• This intensive monitoring, often in an ICU-like setting, is resource-intensive.
• The short half-life of IV tPA suggests prolonged monitoring may not be necessary for all patients.

Purpose of the Study:

• To evaluate the frequency of neurological deterioration in acute stroke patients within 0-12 and 12-24 hour post-treatment windows.
• To identify factors associated with neurological decline at different time points after stroke treatment.

Main Methods:

• Prospective follow-up of 172 acute ischemic stroke patients treated with IV tPA and/or thrombectomy (2016-2018).
• Intensive monitoring with frequent neurological examinations post-therapy.
• Analysis of neurological deterioration, interventions, complications, and associated factors.

Main Results:

• 21% of patients (36/172) experienced neurological deterioration; 4.7% (8/172) had intracerebral hemorrhage.
• Only 5 patients deteriorated between 12-24 hours, most with prior early changes.
• Elevated NIHSS scores and early fluctuations were associated with increased deterioration risk.

Conclusions:

• New neurological deterioration is uncommon 12-24 hours after acute stroke treatment.
• Stable patients with low NIHSS scores and no ICU requirements may be candidates for less than 12-hour intensive monitoring.