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NICE stroke drug guidance updated

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NICE has issued draft guidance on an acute ischaemic stroke treatment, updating the institute’s previous recommendations.

It has been recommended that alteplase (Actilyse, Boehringer Ingelheim) can be used by the NHS, but only if treatment begin as soon as possible, specifically within four-and-a-half hours of the onset of stroke symptoms.

The medication can also only be used after an intracranial haemorrhage has been ruled out by appropriate imaging techniques.

Alterations in the drug’s licence prompted NICE’s update.

The licence now includes an extension of the time period in which the treatment can be used, taking it to within four-and-a-half hours from three hours of the onset of symptoms.

Standard stroke treatment includes both medical and supportive management in a specialist centre while stroke is in its acute (early) phase.

Other treatments include taking measures to stop brain damage progressing, and both physiotherapy and rehabilitative programmes during the period after a stroke.

The alteplase medication is a tissue plasminogen activator. It should be given to the patient during a stroke’s acute phase, and triggers plasmin production.

Plasmin is an enzyme that degrades fibrin clots and therefore helps restore blood flow through the blocked artery.

NICE Health Technology Evaluation Centre director, Professor Carole Longson, said: “The benefits of alteplase in reducing long term disability caused by stroke are well recognised.

“However, because alteplase needs to be given within 4.5 hours of the onset of symptoms, these benefits can only be realised if brain imaging to confirm a diagnosis of acute ischaemic stroke is received as soon as possible, and certainly within one hour of arrival at the hospital, as per the NICE Quality Standard for Stroke.”

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