The 2018 update of the Canadian
Stroke Best Practice Recommendations for
Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of
acute stroke or
transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for
ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient
stroke care. The new module,
Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient
Stroke Care is now a single, comprehensive module addressing the most important aspects of
acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of
intracerebral hemorrhage and
subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular
thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with
stroke of unknown time of onset; and recommendations for dual antiplatelet
therapy for a limited duration after acute minor
ischemic stroke and
transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider's recognition of the signs of
stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a
stroke-enabled Emergency Department without delay; and launching local healthcare institution code
stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent
stroke after
transient ischemic attack/minor
stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize
stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.