Safety and Feasibility of a “Fast-Track” Monitoring Protocol for Patients Treated with Intravenous Thrombolytic Therapy

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Abstract Introduction Our health care systems continue to face significant strain due to chronically taxed intensive care resources. A subgroup of post-thrombolytic stroke patients may not require prolonged intensive monitoring, alleviating some burden. Here we describe the safety, feasibility, and utility of a Fast-Track Protocol (FTP) for early de-escalation of high-acuity monitoring. Methods We compared a prospective cohort of FTP patients at our stroke centers from April 2020 – February 2022 to a similar retrospective cohort. Those on presentation with NIHSS < 10 and without large vessel occlusion or flow-limiting stenosis, intravenous anti-hypertensive use, and any hemodynamic or respiratory concerns were eligible. Primary outcomes included early neurologic deterioration, defined as worsening of NIHSS ≥ 4-points at 24 hours, parenchymal hemorrhage, and symptomatic intracranial hemorrhage. Results Of 574 thrombolysis patients, 119 (21%) were eligible for FTP. One hundred (88%) were included for analysis. The median ± IQR hospitalization was 2.0 ± 1.6 days. None of the four patients with early neurologic deterioration were due to hemorrhage. No symptomatic intracranial hemorrhages occurred, and no FTP patients were transferred back to the ICU. Median ± IQR 90-day modified Rankin scale was 1 ± 1. Discussion FTP is a safe and feasible strategy to triage ICU patients and decrease unnecessary ICU monitoring. This is important in a post-pandemic era as ICU resources continue to fluctuate. Future studies are needed to establish the optimal level of monitoring in post thrombolytic patients.

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