Background and Aims:
The Main Optimal Post rtPA-IV Monitoring in Ischemic Stroke Trial (OPTIMISTmain) demonstrated that low-intensity monitoring is safe and feasible for stable acute ischemic stroke patients post-thrombolysis. However, given the extended half-life of tenecteplase (TNK) compared with alteplase, it remains uncertain whether the safety of reduced monitoring varies by thrombolytic agent. We aimed to evaluate this interaction.
Methods:
Post-hoc analysis of the OPTIMISTmain trial. The type of thrombolysis agent was collected at the baseline. The primary outcome was unfavorable functional recovery (90-day modified Rankin Scale 2–6). Secondary outcomes were 90-day serious adverse events (SAEs) and death. Data were analyzed using a generalized linear mixed model with a random effect for cluster (hospital site), a fixed effect of group assignment of each cluster at each step, and a fixed categorical effect of time
Results:
Of 4,922 participants, 3,725 (75.8%) received alteplase, 772 (15.7%) received TNK, and 416 (8.5%) received other agents. The low-intensity monitoring group had a higher proportion of TNK use compared to the standard monitoring group (19.2% vs. 11.1%). Crucially, the treatment effect of low-intensity monitoring did not vary by thrombolytic agent. There was no significant heterogeneity or interaction between monitoring intensity and agent type for unfavorable outcomes (p-interaction=0.64), SAEs (p-interaction=0.23), or death (p-interaction=0.28).
Conclusion:
The safety and feasibility of low-intensity versus standard monitoring remain consistent regardless of the specific thrombolytic agent administered. These findings support the broad application of simplified monitoring protocols for stable patients following intravenous thrombolysis.