Consider thrombolysis for all stroke patients

ALL stroke patients should be considered for thrombolysis according to a new guideline published by the Intercollegiate stroke working party of the Royal College of Physicians (RCP).

New research has shown that stroke patients formerly not thought to benefit from thrombolysis should now be offered the treatment within three hours of the appearance of stroke symptoms.

The recommendation is one of several updates to the guideline, which acts as a blueprint for stroke care across England and Wales. It includes over one hundred sources of evidence of major developments in stroke research during the past four years and embeds NICE quality standards and guidelines for stroke care.

Stroke remains the third biggest killer in the UK and one of the most important causes of significant adult disability with over 100,000 strokes each year.

Changes to the previous guideline include the recommendation that patients with stroke should be offered 45 minutes of appropriate therapies for a minimum of five days a week in the early stages after stroke in order to meet their rehabilitation goals, and prescribing the anti-platelet drug clopidogrel as the first-line treatment after both stroke and transient ischaemic attack (TIA) because it is better tolerated, more cost-effective and offers a more unified approach to managing both conditions. This contradicts the most recent NICE guidance, which recommends aspirin for TIA because clopidogrel is currently licensed only for the treatment of stroke and not TIA.

The guideline also includes updated sections for rehabilitation, longer-term care after a stroke, and secondary prevention, as well as profession-specific concise guides for nurses, psychologists, primary care physicians, speech therapists, dietitians and therapy professions.

Professor Tony Rudd chair of the Intercollegiate Stroke Working Party, said: "Stroke is a complex disease that requires the skills of multiple professionals to ensure the best quality outcome and the best use of resources. This guideline summarises a wealth of evidence and provide expert consensus statements on areas where the evidence is lacking. No professional should ever use the excuse that they don’t know what the evidence is for treating stroke patients. The patient version of the guideline ensures that patients know what care they should be receiving.”

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