Living guidelines updates
The Stroke Foundation’s Clinical Guidelines for Stroke Management have evolved into the world's first living stroke guidelines as the next generation of health evidence translation.
We continually monitor for new evidence relevant to the guideline topics each month and the content working group reviews content at least every 6 months. In addition to public consultations and recommendation updates listed on this page, the guidelines are republished in MAGICapp whenever there is new evidence added, or changes to practical information or other text. Labels are used to indicate 'new' or 'updated' recommendations. Labels may also note 'Updated evidence, no change in recommendations' and 'In review'. Any topics that have not been updated and hence have no label can be considered current. A full version history be found in the Clinical Guidelines for Stroke Management.
- Draft recommendations for public consultation
- New and updated recommendations
- Suggest new topics or questions
Draft recommendations for public consultation
When new research evidence leads to a change in recommendations, our Guidelines Working Group prepares drafts to be submitted to the NHMRC for approval under section 14A of the National Health and Medical Research Council Act 1992.
As part of the approval process, we are seeking public submissions on the following draft recommendations. Submissions must be received by 5 pm, Friday 28 February 2025.
You can make a submission by following the links below to the MAGICapp platform and leaving a comment under the Feedback tab below each recommendation. Please note you need to sign in to MAGICapp to leave a comment. Create an account for free at MAGICapp.org.
|
Topic |
Change |
|
Several new and updated recommendations for thrombolysis related to tenecteplase. New recommendation against thrombolysis in non-disabling ischaemic stroke. New consensus-based recommendation for dabigatran reversal prior to thrombolysis. |
|
|
New recommendation for acute blood pressure lowering for acute intracerebral haemorrhage, and modification of existing recommendation to focus only on ischaemic stroke. |
|
|
New weak recommendation for care bundle approach to intracerebral haemorrhage. |
New and updated recommendations
Recommendations for the following topics have been updated based on new research evidence, in accordance with the 2016 NHMRC Standards for Guidelines.
| Topic | Date | Change |
| Sleep disorders (Chapter 6) | Dec 2024 | New weak recommendation for continuous positive airway pressure use in sleep-disordered breathing. New practice points on suspected sleep-disordered breathing, and on continuation of treatment for previously diagnosed sleep disorders. Not yet approved by the NHMRC. |
| ICH management -surgical (Chapter 3) | Dec 2024 | New recommendation for minimally invasive haematoma evaculation for lobar ICH and updated consensus-based recommendation adding possible hemicraniectomy following the SWITCH trial. Not yet approved by the NHMRC. |
| Carer support (Chapter 8) | Sept 2024 | Upgrade from consensus-based recommendation to evidence-based recommendation for psychological and social support. Not yet approved by the NHMRC. |
| Cerebral venous thrombosis (Chapter 4) | Sept 2024 | Recommendation updated to include direct oral anticoagulant treatment following new published trials. Not yet approved by the NHMRC. |
| Self-management (Chapter 8) | July 2024 | New recommendation for interventions directed by stroke survivor such as 'Take Charge after Stroke'. Not yet approved by the NHMRC. |
| Management of atrial fibrillation (Chapter 4) | 8/12/2023 | Updated weak recommendation based on a major new trial that specifies when to commence or recommence anticoagulation after ischaemic stroke. |
| Neurointervention (Chapter 3) | 27/07/2023 | Consolidated into one recommendation for endovascular clot retrieval in the internal carotid artery, middle cerebral artery, or basilar artery within 0–24 hours. Added a consensus-based recommendation for extending the time window for clot retrieval past 24 hours if imaging suggests there is salvageable brain tissue. |
| Oxygen therapy (Chapter 3) | 27/07/2023 | Oxygen therapy to be considered when the saturation (SpO2) is less than 92% instead of less than 93%, and the target oxygen level changed to 92–96%, in line with the updated position statement from the Thoracic Society of Australia and New Zealand. |
| Central post-stroke pain (Chapter 6) | 27/07/2023 | New topic, with a consensus-based recommendation for cautious trials with planned follow-up of tricyclic antidepressant or antiepileptic medication to reduce pain, and non-pharmacological interventions only to be used within a research framework. |
| Driving (Chapter 8) | 27/07/2023 | Updated consensus recommendation, including non-driving periods following stroke or TIA and the process for fitness-to-drive assessments, to be consistent with the new edition of Assessing Fitness to Drive by Austroads (2022) and to include the Medical Aspects of Fitness to Drive by Waka Kotahi NZ Transport Agency. |
| Aphasia (Chapter 6) | 6/12/2022 | Communication partner training should be provided to health professionals or volunteers who interact with people with aphasia after stroke, and it may also be provided to their carers or family members. |
| Urinary incontinence (Chapter 6) | 6/12/2022 | Weak recommendation for structured continence management plans, for patients in hospital with confirmed continence difficulties, updated with new evidence. |
| Pre-hospital care (Chapter 1) | 5/08/2022 | New recommendation for pre-hospital treatment in a mobile stroke unit, for eligible patients in major cities. |
| Assessment for rehabilitation (Chapter 3) | 5/08/2022 | Updated wording in practice point to clarify that options include locally developed assessment tools (not subject to public consultation). |
| Aphasia (Chapter 5) | 5/08/2022 | Speech and language therapy now recommended to improve reading and auditory comprehension, and general expressive and written language, in addition to functional communication. Upgraded from weak to strong recommendation for early aphasia therapy starting in the first 4 weeks post stroke. New weak recommendation for intensive aphasia therapy for stroke survivors with chronic aphasia, plus changes to weak recommendation for intensity of aphasia therapy in the acute phase. Updated wording in weak recommendation against brain stimulation. |
| Dysarthria (Chapter 5) | 5/08/2022 | Tailored interventions that include speech production tasks targeting connected speech may be provided, e.g. reducing rate of speaking, emphasising articulatory placement or increasing loudness. Removed recommendation against non-speech oromotor exercises, which is addressed in the practical info of the main recommendation. |
| Prevention of depression (Chapter 6) | 5/08/2022 | Changed from weak recommendation against to weak recommendation for antidepressant medication. |
| Treatment for depression (Chapter 6) | 5/08/2022 | Recommendation for antidepressants changed from strong to weak, plus new recommendation that psychological therapy may be used, and updated recommendation for structured exercise programs to include resistance training. Non-invasive brain stimulation changed to weak recommendation for, from weak against. |
| Treatment for anxiety (Chapter 6) | 5/08/2022 | New consensus recommendation that psychological therapy and/or relaxation strategies may be trialled, with the addition of pharmacotherapy carefully considered. |
| Personality and behaviour (Chapter 6) | 5/08/2022 | New consensus recommendation that behavioural changes should be assessed and addressed through individually tailored interventions for survivors of stroke and their families/carers. |
| Pressure injury (Chapter 6) | 5/08/2022 | Reestablished practice point that staff and carers of patients at risk of pressure injuries should be trained to assess, provide care and treat pressure injuries consistent with existing guidelines. |
| Pre-hospital care (Chapter 1) | 22/12/2021 | New practice point for regular education to help clinicians identify stroke patients. |
| Acute stroke telehealth services (Chapter 3) | 22/12/2021 | New topic with recommendation for telestroke systems to help assess patients for thrombolysis and transfer for endovascular therapy, where 24/7 onsite specialists are unavailable. |
| Head position (Chapter 3) | 22/12/2021 | New topic with recommendation that any position may be used in the first 24 hours after hospital admission, while in bed and not receiving nasogastric feeding. |
| Management of atrial fibrillation (Chapter 4) | 22/12/2021 | Closing off the opening to the left atrial appendage may be reasonable when long-term anticoagulation is not possible. |
| Lifestyle modifications (Chapter 4) | 22/12/2021 | Everyone who has had a stroke or TIA may be given interventions addressing secondary stroke risk factors, with support and counselling, reviews by health care professionals, and exercise training. Also, a new consensus recommendation for a Mediterranean or similar style diet, and referral to a dietitian for individualised advice. |
| Arm activity (Chapter 5) | 22/12/2021 | Virtual reality and interactive games may now be used with any timing and duration, and independently of impairment severity. |
| Memory (Chapter 5) | 22/12/2021 | Cognitive rehabilitation, including both internal strategies and external aids, may be used to improve memory function in the short term. |
| Telehealth in rehabilitation (Chapter 5) | 22/12/2021 | New topic with recommendation that telehealth services may be used as an adjunct to in-person therapy, or an alternative for patients who cannot access specialist rehab in the community. |
| Swelling of the extremities (Chapter 6) | 22/12/2021 | Passive mobilisation is now recommended for prevention and management, along with elevation of the limb when resting. |
| Antiplatelet therapy (Chapter 4) | 7/07/2021 | Restarting antiplatelet therapy can be considered after the acute phase of an intracerebral haemorrhage if the person was previously on antithrombotic therapy. |
| Standing (Chapter 5) | 7/07/2021 | Recommendation for task-specific practice now split into a strong recommendation for activities that challenge balance, plus a weak recommendation for adding on virtual reality training, visual or auditory feedback or electromechanical assistance. |
| Activities of daily living (Chapter 5) | 7/07/2021 | Updated from strong recommendation against to a weak recommendation against routinely using acupuncture to improve activities of daily living. In addition, a new weak recommendation against using selective serotonin reuptake inhibitors to reduce disability. |
| Fatigue (Chapter 6) | 7/07/2021 | Minor wording changes and a mention of cognitive behavioural therapy as a possible intervention. |
| Sexuality (Chapter 8) | 7/07/2021 | New evidence added, but no change in recommendation apart from minor wording changes. |
| Acute antiplatelet therapy (Chapter 3) | 11/02/2021 | A new drug, ticagrelor, in combination with aspirin soon after a minor ischaemic stroke or high-risk transient ischaemic attack, may be considered to prevent another stroke. |
| Oxygen therapy (Chapter 3) | 11/02/2021 | More specific targets and thresholds set for blood oxygen levels, above which supplemental oxygen should not be given. |
| Cholesterol lowering therapy (Chapter 4) | 11/02/2021 | A new target set for lowering LDL cholesterol to prevent further strokes and cardiovascular disease. |
| Weakness (Chapter 5) | 11/02/2021 | Added new evidence for recovery of muscle strength with progressive resistance training. Also a new recommendation for certain types of repetitive practice. |
| Shoulder pain (Chapter 6) | 11/02/2021 | Electrical stimulation may now be used for pain management, when previously it was recommended against. Acupuncture may also be used to reduce pain. |
| Thrombolysis (Chapter 3) | 7/11/2019 | Time window for intravenous thrombolysis extended up to 9 hours after a person has had their stroke, if brain scans show they will benefit. The 9 hours can be counted from the mid-point of sleep if the person woke up with stroke symptoms. Tenecteplase may also be used in thrombolysis as an alternative to alteplase, especially for people with a blockage in large brain arteries. |
| Acute antithrombotic therapy (Chapter 3) | 7/11/2019 | Upgrade to strong recommendation for taking the antiplatelet medications aspirin and clopidogrel together in the first three weeks after a minor stroke or transient ischaemic attack (TIA). |
| Patent foramen ovale (PFO) management (Chapter 4) | 7/11/2019 | Closing a PFO (patent foramen ovale) is recommended when people under 60 years old have had a stroke, and other possible causes of their stroke have been ruled out. |
See all current recommendations in the Clinical Guidelines for Stroke Management.
Suggest a new topic or question
To keep our living guidelines relevant, we annually review the topics the guidelines cover and the questions about practice that they answer. The current topics make up the table of contents of the Clinical Guidelines.
We welcome your suggestions for new topics that you believe are critical to include. New topics will be considered during our project steering committee's annual review.
Please email your suggestions to guidelines@strokefoundation.org.au
Stroke Foundation respectfully acknowledges the Traditional Owners and Custodians of Country throughout Australia, whose sovereignty was never ceded, and acknowledges their continuing connection to land, water, sky and community. We pay our respect to the peoples, cultures, and Elders past, present and emerging, for they hold the memories, culture and hope of their peoples.
© 2024 Stroke Foundation ABN 42 006 173 379 - All donations $2 and over are tax deductible