COMMENTARY

New Stroke Guidelines: The Treatment Window Is Wider Than You Thought

Arefa Cassoobhoy, MD, MPH

Disclosures

February 09, 2018

Hello. I'm Dr Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD. Welcome to Morning Report, our 1-minute news story for primary care.

The American Heart Association and the American Stroke Association have released updated stroke treatment guidelines based on the success seen in two new trials, DEFUSE-3[1] and DAWN.[2]

A key change extends the window for mechanical thrombectomy from 6 hours up to 24 hours in eligible patients. Also, the guidelines broaden who qualifies for intravenous tissue plasminogen activator (tPA), partly by reducing the number of absolute contraindications. Patients with acute stroke can potentially get tPA and then be transported immediately to a hospital that can do a thrombectomy, if it's still needed. Even patients who can't receive tPA—because, for example, they're on warfarin—may qualify for the clot removal procedure.

The guidelines also encourage secondary stroke prevention to start sooner. Carotid revascularization for patients with a minor, nondisabling stroke can now be done within 2-7 days instead of waiting. I've added a link to the original guidelines in the journal Stroke [3] for you to get more information.

Follow Dr Cassoobhoy on Twitter at @ArefaMD

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