{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T11:35:05Z","timestamp":1767353705971,"version":"3.48.0"},"reference-count":11,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Intravenous thrombolytic therapy remains the cornerstone of managing acute ischemic stroke (AIS) patients. Given the potential adverse effects of thrombolysis, patients are admitted to an intensive care unit (ICU) for close monitoring following administration. Alternative post-thrombolytic pathways may provide safe, cost-effective care in certain populations. We aimed to determine the proportion of patients treated with thrombolytics who required ICU care for reasons other than frequent neurologic monitoring and to define their characteristics. Methods: We retrospectively (May 2020\u2013August 2022) reviewed patients \u2265 18 years of age who received Tenecteplase (TNK) or tissue plasminogen activator (tPA) for AIS at our stroke center. Patients were classified as requiring ICU care if they required intubation within 24 h of admission, required neurosurgical intervention, had symptomatic hemorrhagic conversion or brain compression, required a continuous infusion for hemodynamic management, or were in status epilepticus. Univariate and multivariable statistical analyses were performed. The study protocol was deemed exempt by our Institutional Review Board. Results: 262 patients met inclusion criteria. A total of 54 (20.6%) required ICU care. Multivariable analysis showed that patients on antithrombotic therapies prior to arrival (AOR: 3.344, p = 0.002) or who presented with higher initial NIH stroke scale (AOR: 1.116, p &lt; 0.001) had a significantly higher likelihood of requiring an ICU level of care. Conclusions: In our cohort, approximately 21% of patients required critical care. Antithrombotic therapy before admission and greater NIH stroke scale on arrival were associated with an increased likelihood of requiring ICU care. Further prospective studies are indicated to assess the efficacy of alternative settings for post-thrombolytic care in selected AIS patients; however, our findings suggest that a specific subset of patients with AIS can be safely and effectively cared for in a non-ICU setting. This may have implications for the provision of safe, effective care while optimizing healthcare resource utilization.<\/jats:p>","DOI":"10.3390\/jcm15010324","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T11:11:46Z","timestamp":1767352306000},"page":"324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Critical Care After Thrombolytic Therapy in Acute Stroke: Who Really Needs the ICU?"],"prefix":"10.3390","volume":"15","author":[{"given":"Katherine G.","family":"Moore","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathaniel S.","family":"Harshaw","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha K.","family":"LaRosa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daria","family":"Indeck","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Cross","sequence":"additional","affiliation":[{"name":"Department of Neurology, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Chiota-McCollum","sequence":"additional","affiliation":[{"name":"Department of Neurology, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1930-1175","authenticated-orcid":false,"given":"Lindsey L.","family":"Perea","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the Early Management of Patients with Acute Ischemic Stroke","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1292","DOI":"10.1212\/WNL.0000000000013302","article-title":"Safety and Efficacy of Tenecteplase in Older Patients with Large Vessel Occlusion: A Pooled Analysis of the EXTEND-IA TNK Trials","volume":"98","author":"Yogendrakumar","year":"2022","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1161\/STROKEAHA.118.021398","article-title":"Shorter Intensive Care Unit Stays? The Majority of Post-Intravenous tPA (Tissue-Type Plasminogen Activator) Symptomatic Hemorrhages Occur Within 12 Hours of Treatment","volume":"49","author":"Chang","year":"2018","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1056\/NEJMoa1716405","article-title":"EXTEND-IA TNK Investigators; et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke","volume":"378","author":"Campbell","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1177\/19418744211048014","article-title":"Shorter Intensive Care Unit Stay (12 Hours) Post Thrombolysis Is Safe and Reduces Length of Stay for Minor Stroke Patients","volume":"12","author":"Cencer","year":"2022","journal-title":"Neurohospitalist"},{"key":"ref_6","first-page":"e001098","article-title":"Safety and Feasibility of a \u201cFast-Track\u201d Monitoring Protocol for Patients Treated with Intravenous Thrombolytic Therapy","volume":"4","author":"Fukuda","year":"2024","journal-title":"Stroke Vasc. Interv. 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Palliat. Med."},{"key":"ref_11","first-page":"1","article-title":"Factors associated with prolonged intensive unit stay following mechanical thrombectomy for acute ischemic stroke","volume":"12","author":"Chaudhry","year":"2025","journal-title":"Neurol. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T11:31:05Z","timestamp":1767353465000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010324"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010324","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]}}}