This guideline covers interventions in the acute stage of a stroke or transient ischaemic attack (TIA). It offers the best clinical advice on the diagnosis and acute management of stroke and TIA in the 48 hours after onset of symptoms, although some interventions of up to 2 weeks are covered as well.
In March 2017, recommendation 188.8.131.52 was updated as the source guidance for this recommendation had been superseded by new advice. The footnote to recommendation 184.108.40.206 was amended to give a definition of aspirin intolerance, rather than a link to a definition.
This guideline includes recommendations on:
- recognising symptoms rapidly and diagnosis
- imaging in people who have had a suspected TIA or non-disabling stroke
- specialist care for people with acute stroke
- pharmacological treatments for people with acute stroke
- maintenance or restoration of homeostasis
- nutrition and hydration
- early mobilisation and optimum positioning of people with acute stroke
- avoiding aspiration pneumonia
- surgery for people with acute stroke
Who is it for?
- Healthcare professionals
- People who have had a stroke or TIA, their families and carers
Is this guideline up to date?
We checked this guideline in January 2017 and we are updating the following recommendations:
- referral for specialist assessment and subsequent imaging in people with suspected transient ischaemic attack
- use of pharmacological or mechanical methods for clearing blood clots
- early antihypertensive treatment in haemorrhagic stroke
- decompressive hemicraniectomy in people older than 60 year
See the guideline in development page for progress on the update.
Guideline development process
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.