New stroke guidelines stress fast treatment, involvement of caregivers outside hospital

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Rapid treatment and vigilant, trained post-acute care providers allow the damage caused by strokes to be minimized, according to guidelines released Thursday by the American Stroke Association.

The guidelines stress that individuals presenting stroke symptoms should be quickly transported via ambulance or air to the nearest comprehensive stroke center for administration of clot-dissolving drugs. To be effective, the dissolver recombinant tissue plasminogen activator (tPA) must be given within 4.5 hours of symptom onset. In all appropriate cases, tPA should be administered within 60 minutes of a patient arriving at a hospital, the guidelines state.

If a patient must be treated at a hospital lacking a primary or comprehensive stroke center, attending physicians should consider telemedicine to connect with stroke experts, according to the guidelines.

Effective stroke response is not dependent on hospital resources alone, as long-term caregivers play a part in recognizing stroke symptoms, researchers said.

"It's not just a single person managing a stroke that makes a difference. It's creating a process that involves patients, people around patients, pre-hospital care and hospitals," said guideline lead author Edward Jauch, M.D., director of the division of emergency medicine at the Medical University of South Carolina. "When all these pieces are in place, the patient has the best chance for having a good outcome."

The guidelines will be printed in the March issue of the journal Stroke.

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