The treatment of acute ischemic stroke will change due to new American Heart Association and American Stroke Association guidelines. Help update your hospital's screening and treatment protocols... Strive for faster turnaround times in stroke patients. For example, aim to rule out a hemorrhagic stroke with brain imaging within 20 minutes even though the quality measure is 45 minutes.
Mechanical thrombectomy. Expect more patients to receive this treatment, or be transferred to a hospital that can perform it. New evidence suggests thrombectomy may reduce disability when performed in eligible patients up to 24 hours after symptom onset, instead of just 6 hours even if they've received alteplase.
Alteplase (Activase). Verify your criteria are current. For example, avoid alteplase if a low-molecular-weight heparin (Clexane) is used in the previous 24 hours at TREATMENT doses. But PROPHYLACTIC doses are okay. New evidence suggests tenecteplase may be a better option, but it's too soon to recommend switching. Stick with alteplase for now.
VTE prophylaxis. Continue to use mechanical compression devices such as Sequential Compression Device (SCDs, etc) in immobile patients. But don't jump to using medications for VTE prophylaxis. The risk of intracranial hemorrhage in ischemic stroke patients is similar to the reduction in symptomatic pulmonary embolism (PE). Work with neurology specialists to determine which patients may be more likely to benefit. Continue to document VTE prophylaxis or reason for not using by day 2 of admission for all patients to meet the Joint Commission measure. Before discharge, evaluate chronic medication needs, starting antihypertensive medications or statins in-house is associated with better long-term control.
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