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Updated: Apr 21, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Early Mobilization Outcomes With Tenecteplase Treatment in Acute Ischemic Stroke (EMOTE-TNK) Study: Safety and
Isabelle Delos Reyes1,2, Saptarshi Ghosh3, Olivia Boykin1,4
1Department of Neurocritical Care, Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, FL.
Objective:
To evaluate the safety and tolerability of early mobilization among patients with acute ischemic stroke (AIS) receiving intravenous (IV) tenecteplase (TNK). We hypothesized that physical therapy and occupational therapy would be relatively safe and tolerable when mobilization was attempted shortly after thrombolysis.
Patients And Methods:
In this single-center, single-arm retrospective cohort study, we included adults with AIS treated with IV TNK who underwent first physical therapy or occupational therapy screening and mobilization 13 hours or more but less than 24 hours after thrombolysis. The primary outcome was mobilization-associated adverse events (AEs; screening through the immediate recovery period). Tolerability was defined by whether patients could continue mobilization after screening. We used health record data to determine stroke severity (National Institutes of Health Stroke Scale score, modified Rankin scale score), vital signs, AE type, and symptomatic intracranial hemorrhage occurring after thrombolysis but before mobilization.
Results:
Of 180 patients, 159 (88.3%) underwent early mobilization without any AE. Twenty-one patients (11.6%) had an AE (orthostasis, dizziness, pain, heart rate >120/min, or systolic blood pressure >180 mm Hg); all were mild, transient, and not life threatening. Adverse events were significantly associated with baseline mean arterial pressure (P<.01). Moreover, AE type (pain vs autonomic; P=.01) and initial National Institutes of Health Stroke Scale score (P=.04) were associated with successful mobilization. Three patients had symptomatic intracranial hemorrhage.
Conclusion:
Early mobilization (<24 hours after IV TNK) was relatively safe and well tolerated. Our findings suggest that screening-based early mobilization strategies can be integrated into standardized protocols for select patients with AIS receiving TNK.
