Stroke and TIA – initial management

This is an updated guideline from NICE on the management of stroke and TIA in over 16s. It was first published in 2008 and this update is from May 19.

The most important change for us in this guideline is that they recommend that all patients with a suspected TIA now be seen by a specialist within 24hrs. We should no longer use the ABCD tool to assess risk.

Most of us are used to using the ABCD tool to stratify patient risk after a suspected TIA. Those deemed to be high risk are seen quickly and those at lower risk are seen within 7d. So why should we no longer use the ABCD tool? Evidence suggests that the ABCD tool is not good at predicting those who go onto have stroke. If everyone is seen with 24 hrs, it both improves outcomes and saves money (by reducing the number of people going onto have strokes).  The expectation is that TIA clinics will now run 7 days a week.

Are there any other changes in this guideline?

Not that are relevant to us really. There are a few things that we may see in our discharged patients:

TIA - MRI should be considered in patients diagnosed with a TIA. It should be done the same day if so.

Thrombectomy - the guidance on this has been bought into the main guideline. Some patients who have had a stroke will be suitable for thrombectomy.

Rapid lowering of BP - this may be considered for patients after a haemorrhagic stroke with raised BP. The aim is to get the BP down to normal within 1 hr and to maintain it for 7 days.

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