Stroke Guidelines Update 2023

If a treatment isn't mentioned in this guideline, it's not recommended.

Some treatments should only be offered within clinical research studies.

Guideline recommendations don't state if a medicine is licensed for its use.

Medication not approved by regulatory agencies (MHRA or EMA) for specific use.

Other organizations (NICE, SMC, NCPE) provide extra advice on medicine use.

Stroke rehabilitation units must have access to a consultant specializing in stroke rehabilitation, which can be a medical or non-medical professional (e.g., nurse, therapist) where regulations allow.

Stroke rehabilitation units needing non-medical consultant leadership must have daily medical cover (ward doctors or GPs) to enable admissions and discharges every day of the week.

Patients needing continued rehabilitation after a stroke but ineligible for early supported discharge should be referred to community stroke rehabilitation programs.

The intensity and duration of community stroke rehabilitation should be determined by the stroke specialist and the patient, based on clinical needs, specific goals and patient outcomes.

A multidisciplinary service providing both early supported discharge and community stroke rehabilitation needs to have a core team structure.

In case of patients with limited life expectancy, the team must determine whether patient wishes regarding eating/drinking management is documented.

Aspirin and clopidogrel, or aspirin and ticagrelor, should be considered for patients within 24 hours of TIA or minor stroke.

Patients with acute ischaemic stroke within 4.5 hours of onset could be considered for thrombolysis with alteplase or tenecteplase.

Patients with acute ischemic stroke more than 4.5 hours after onset could possibly get thrombolysis between 4.5-9 hours if CT perfusion or MRI shows salvageable brain tissue.

A specialist acute stroke service includes a comprehensive stroke center (CSC) or acute stroke center (ASC) that provides hyperacute, acute, and inpatient rehabilitation. A stroke rehabilitation unit (SRU) offers inpatient rehabilitation only.

A specialized unit for immediate stroke care; used for patients showing persisting neurological symptoms after initial screening.

Community clinicians (like paramedics) should screen patients with sudden neurological symptoms for hypoglycemia and potential stroke or TIA using validated tools.

Rapid specialized care following stroke onset to diminish long-term brain damage, disability, and healthcare costs

A scientifically proven tool used for diagnosing stroke or transient ischemic attack (TIA).

Regional/subregional stroke services need to be organized to optimize treatment benefits and patient outcomes, considering other emergency services.

Disorganized systems for treating stroke patients lead to negative outcomes, despite individual clinician efforts.

Clinical teams lacking the necessary expertise and consistency in stroke treatment result in suboptimal patient care.

Recurring campaigns targeting high-risk individuals to increase public understanding of stroke symptoms, prevention, and treatment.

A mass media campaign to increase public awareness of stroke symptoms.

Healthcare professionals with advanced knowledge and skills to treat stroke and similar conditions, often with further qualifications and continuing professional development.

Strategies/techniques, methods, tools supported by evidence from studies/research.

Campaigns repeated over time rather than being short-term.

All staff involved in acute stroke care (ambulances, ED) must receive training.

Healthcare providers in stroke care need ongoing training.

Acute stroke services should be part of programs monitoring stroke patient care.

Acute stroke services should be involved in multicenter research.

Acute stroke services must participate in quality improvement programs.

About 1 in 20 strokes happen to patients already in hospital.

A service providing immediate post-hospital care and support at home, starting within 24 hours of discharge for mild-moderate stroke patients.

Ongoing rehabilitation for stroke patients who don't qualify for early supported discharge, delivered in the community.

A team of healthcare professionals (e.g., doctors, therapists) working collaboratively to provide comprehensive stroke care.

The level and length of treatment, determined by the patient's needs and goals in collaboration with the stroke specialist and family/carers.

Stroke rehabilitation provided in the patient's own home, residential facility, or nursing home.