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Clot-busting stroke treatment should be offered to all

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All acute patients presenting with stroke should be considered for thrombolysis, regardless of age or stroke severity, according to latest national guidelines.

Research has shown these categories of patient, formerly not thought to benefit from thrombolysis, should now be offered it within three hours of the appearance of symptoms – like other stroke patients.

The recommendation forms part of the latest edition of the National Clinical Guidelines for Stroke, drawn up by the Intercollegiate Stroke Working Party. It updates an earlier version from 2008.

Working party chair Tony Rudd said: “This guideline summarises a wealth of evidence and provide expert consensus statements on areas where the evidence is lacking.”

In addition to the update on thrombolysis, the guidance states that stroke patients should be offered 45 minutes of appropriate therapies for a minimum of five days a week in the early stages after stroke. This should continue for as long as the therapy is of benefit and the patient can tolerate it.

It recommends that all patients should have a brain scan within a maximum of 12 hours. This is a reduction from the 24 hours in the previous version of the guidance and is intended to ensure all patients admitted out of hours are scanned the following day.

The guidance also recommends the anti-platelet drug clopidogrel as the first line treatment after both stroke and transient ischaemic attack. Aspirin was previously favoured for TIA.

The document highlights that care needs to be integrated across the entire stroke care pathway. It includes updated sections for rehabilitation, longer-term care after a stroke and secondary prevention, as well as a nurse-specific concise guide.

Professor Peter Langhorne, president of the British Association of Stroke Physicians, added: “In the UK, stroke physicians and their multidisciplinary team colleagues are very fortunate to have ready access to such a comprehensive, rigorous and up-to-date source of guidance that covers all their respective areas of interest. Please use it.”

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