Abstract DP177: 12 versus 24 h Bed Rest After Acute Ischemic Stroke Thrombolysis: A 14-year Retrospective Cohort Study

Background: The practice of a minimum of 24 hour bed rest following thrombolytic therapy for acute ischemic stroke (AIS) is a widely adopted standard of care among hospitals, yet its benefit over earlier mobilization is unclear. We aimed to determine whether discharge outcomes, in-hospital complications, and readmission rates were more favorable in AIS patients treated with thrombolysis who followed a ≥12-hour versus ≥24-hour bed rest protocol. 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. Primary outcome was favorable discharge location (defined as home, inpatient rehabilitation facility, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, length of stay, 90-day modified Rankin scale (mRS) scores, and readmission rates. Results: 1321 patients were identified (466 in the ≥12-hour group, 855 in the ≥24-hour group). Mean (s.d.) age in the ≥12 hour group was 70.4 (14.0) and 72.3 (14.6) in the ≥24-hour group; median (IQR) NIHSS was 5.0 (2-9) and 7.0 (3-14), respectively. 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 χ 2 p-value=0.40) and 90 days (15.6% vs. 16.1%, LR χ 2 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%, χ 2 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 χ 2 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 χ 2 p<0.001) and in multivariable logistic regression analysis (adjusted OR=1.34; 95% CI=1.01:1.86) favoring the 12-hour group. Conclusion: 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-suggesting a potential benefit with earlier mobilization that warrants further investigation in randomized studies.