12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience

Brian Silver, Tariq Hamid, Muhib Khan, Mario DiNapoli, Reza Behrouz, Gustavo Saposnik, Jo Ann Sarafin, Susan Martin, Majaz Moonis, Nils Henninger, Richard Goddeau, Adalia Jun-O'Connell, Shawna M. Cutting, Ali Saad, Shadi Yaghi, Wiley Hall, Susanne Muehlschlegel, Raphael Carandang, Marcey Osgood, Bradford B. ThompsonCorey R. Fehnel, Linda C. Wendell, N. Stevenson Potter, James M. Gilchrist, Bruce Barton

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Abstract

Background: The practice of ≥24 h of bed rest after acute ischemic stroke thrombolysis is common among hospitals, but its value compared to shorter periods of bed rest is unknown. Methods: Consecutive adult patients with a diagnosis of ischemic stroke who had received intravenous thrombolysis treatment from 1/1/2010 until 4/13/2016, identified from the local ischemic stroke registry, were included. Standard practice bed rest for ≥24 h, the protocol prior to 1/27/2014, was retrospectively compared with standard practice bed rest for ≥12 h, the protocol after that date. The primary outcome was favorable discharge location (defined as home, home with services, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, NIHSS at discharge, and length of stay. Results: 392 patients were identified (203 in the ≥24 h group, 189 in the ≥12 h group). There was no significant difference in favorable discharge outcome in the ≥24 h bed rest protocol compared with the ≥12 h bed rest protocol in multivariable logistic regression analysis (76.2% vs. 70.9%, adjusted OR 1.20 CI 0.71–2.03). Compared with the ≥24 h bed rest group, pneumonia rates (8.3% versus 1.6%, adjusted OR 0.12 CI 0.03–0.55), median discharge NIHSS (3 versus 2, adjusted p = .034), and mean length of stay (5.4 versus 3.5 days, adjusted p = .006) were lower in the ≥12 h bed rest group. Conclusion: Compared with ≥24 h bed rest, ≥12 h bed rest after acute ischemic stroke reperfusion therapy appeared to be similar. A non-inferiority randomized trial is needed to verify these findings.

Original languageEnglish (US)
Article number116618
JournalJournal of the Neurological Sciences
Volume409
DOIs
StatePublished - Feb 15 2020

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ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Silver, B., Hamid, T., Khan, M., DiNapoli, M., Behrouz, R., Saposnik, G., Sarafin, J. A., Martin, S., Moonis, M., Henninger, N., Goddeau, R., Jun-O'Connell, A., Cutting, S. M., Saad, A., Yaghi, S., Hall, W., Muehlschlegel, S., Carandang, R., Osgood, M., ... Barton, B. (2020). 12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience. Journal of the Neurological Sciences, 409, [116618]. https://doi.org/10.1016/j.jns.2019.116618