Updates for thrombolysis, acute blood pressure lowering therapy and medical management for intracerebral haemorrhage

The latest updates to the Australian and New Zealand Living Clinical Guidelines for Stroke Management include several new and updated recommendations for intravenous thrombolysis related to Tenecteplase. There is a new recommendation against thrombolysis in non-disabling ischaemic stroke and a new consensus-based recommendation for dabigatran reversal prior to thrombolysis.

For acute blood pressure lowering therapy, there is a strong recommendation for acute blood pressure lowering for acute intracerebral haemorrhage, and modification of the existing recommendation to focus only on ischaemic stroke.

Additionally, there is a new weak recommendation for care bundle approach to intracerebral haemorrhage.

These updates were approved by the National Health and Medical Research Council (NHMRC) on the 3rd of September 2025.

The Clinical Guidelines for Stroke Management continue to follow a living evidence approach, where monthly searches for new research evidence feed into 6-monthly reviews and updates where appropriate.

For further updates, we suggest you regularly check our Living guidelines updates.