Abstract DP147: Early Mobility Following TNK for Acute Ischemic Stroke Is Safe And Demonstrated Decreased Length of Stay in ICU.

Introduction: Due to the advancements in the administration of fibrinolytic therapy for acute ischemic stroke, research is emerging regarding the duration of bed rest following fibrinolytic therapy. With use of tissue plasminogen activator (tPA) patients often remained on strict bedrest for 24 hours until follow up imaging was completed to rule out post procedural bleeding. Tenecteplase (TNK) has been shown to have an improved ability to dissolve clots and decreased risk of intracranial hemorrhage (ICH) compared to tPA. An Early Mobility Protocol has been developed to operationalize mobilization as early as 12 hours following TNK. The purpose of this study is to evaluate the safety and outcomes of out of bed mobility as early as 12 hours post TNK. Methods: All patients admitted to Capital Health with acute ischemic stroke receiving TNK from September 2023 through May 2025 were included (n=166) 10 patients were excluded as they never participated in out of bed mobility (n=156). Data was collected by retrospective chart review. Patients were divided into 2 groups: patients who remained on bed rest at least 24 hours after TNK (n=60) and patients mobilized out of bed 12-24 hours post TNK (n=96). Adverse events during Physical and Occupational therapy sessions and within the first 48 hours post TNK were recorded. Adverse events during therapy were defined as patients reaching termination criteria impacting their ability to participate in full mobility assessment. Medical adverse events were defined as a neurologic change of 4 or more on the National Institute of Health Stroke Scale or patients requiring positional restrictions and/or vasopressors to facilitate cerebral perfusion. Results: This study showed that patients participating in early mobility had a decreased incidence in adverse events, both in therapy sessions (3.1% vs 11.6%, p=0.017) and medical complications (7.3% vs 18.3%, p=0.018). This study also found patients in the early mobility group had a decreased ICU length of stay (44 hours vs 61 hours, p=0.031) In conclusion, patients receiving TNK following acute ischemic infarct can safely be mobilized out of bed as early as 12 hours after administration, with close monitoring and appropriate patient selection. Additional research is warranted to further investigate if early mobility leads to decreased hospital length of stay, cost of care, and improved functional outcomes.