Abstract 121: Early Mobilization of Ischemic Stroke Patients post Intravenous Tissue Plasminogen Activator

Background/Purpose: Research about mobilization of patients who receive IV-tPA is scarce. Patients are routinely kept on bed rest for 24-48 hours after tPA for monitoring despite a lack of evidence justifying this lengthy immobilization. Several stroke rehabilitation studies report mobilizing patients within 24 hours of stroke. However, none of these studies included patients who received tPA and there are no published recommendations for safe timeframes for initiating mobilization of these patients. We completed a preliminary study to assess the hypothesis that adverse safety outcomes of early mobilization of this patient population are minor. Methods: We conducted a study between June 2011 and July 2012 involving early mobilization (i.e. PT/OT between 13 and 24 hours) of patients administered tPA. A safety screen was performed before mobilization occurred to verify hemodynamic stability of patients. Mobilization may have included sitting, standing, transferring to a chair, and ambulation. Results: Nearly 97% (30/31) of patients provided consent (12 female, 18 male; mean age: 66.8, range: 32-89; mean admission NIHSS 5.37, range 0 - 27). All consented patients were screened and 23/30 were mobilized without adverse response. Eighty-six percent (70/81) of activity events had no adverse response. The adverse events that were observed were transient and minor: 2 subjects reported “dizziness” (without a corresponding drop in BP), 3 subjects had an increase in DBP to > 105 (with resting DBPs as follows: 93, 104, and 62 mmHg), 1 subject had a HR > 100 bpm (resting HR was 96 bpm), and 1 had new-onset of neurological signs (transient L hemiparesis that resolved within an hour). Analysis is currently being performed Biostatistician. Conclusion: Early mobilization of patients post ischemic stroke 13-24 hours after IV-tPA infusion appears safe for 76.7% of patients and during 86.4% of activity events. In conclusion, adverse responses were largely minor with no sustained worsening of neurologic deficits. Study investigators recommend larger-powered studies for validation of safety findings to develop evidenced-based guidelines for early mobilization of this patient population.