196 - Stretching the Stroke Clock to 2026: A Brief Review of the 2026 Acute Ischemic Stroke Guidelines
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
Sean P. Kane, PharmD, BCPS
4.9 • 650 Ratings
🗓️ 18 March 2026
⏱️ 38 minutes
🧾️ Download transcript
Summary
In this episode, we review key updates from the 2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke, including changes to IV thrombolysis, antiplatelet therapy, endovascular treatment, blood pressure goals, and glycemic goals.
Key Concepts
- Tenecteplase (TNKase) is now equally preferred to alteplase (Activase) by the 2026 AHA/ASA guidelines. Tenecteplase has several advantages related to administration and the risk of medication errors.
- IV thrombolysis can be given in selected patients up to 9 hours after stroke symptom onset depending on brain imaging findings. Patients with symptom onset less than 4.5 hours are still eligible for IV thrombolysis regardless of brain imaging findings.
- IV thrombolysis should not be given for mild, non-disabling stroke symptoms. A "non-disabling" stroke means the symptoms do not impair activities of daily living or ability to return to work.
- The criteria for dual antiplatelet therapy (DAPT) has been updated. DAPT can be given for NIHSS of 4 or 5 (not just 3 or less) and can be started up to 72 hours after stroke onset (not just within 24 hours).
References
- Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. Published online January 26, 2026. doi:10.1161/STR.0000000000000513
Transcript
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| 0:00.0 | Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions. |
| 0:11.1 | This podcast is provided by pharmacists and faculty members at Rosalne Franklin University College of Pharmacy. |
| 0:17.4 | This podcast contains general information for educational purposes only. This is not professional |
| 0:22.4 | advice and should not be used in lieu of obtaining advice from a qualified health care provider. |
| 0:27.2 | And now, on to the show. |
| 0:31.2 | Welcome to Helix Talk, episode 196. I'm your co-host, Dr. Kane. And I'm Dr. Patel. |
| 0:36.9 | And I'm so excited for today's episode, which is entitled Stretching the Stroke Clock to |
| 0:41.1 | 26, a Brief Review of the 2026 Acute Schemic Stroke guidelines. |
| 0:46.7 | And for today, we're really talking about these new 2026 H-A-AASA guidelines. |
| 0:52.7 | And to help us do that, we have Dr. Rachel New here. So, Dr. Rachel New, do you want to kind of introduce yourself to the Helix Talk audience? Sure. It has been a while since I last came on board. So my name is Dr. New, and I am one of the clinical faculty here at RFU College of Pharmacy. So with my position, I pretty much have a split position so 30% of my time I'm teaching here at a college of pharmacy. So with my position, I pretty much have a split position. So 30% of my time, |
| 1:13.4 | I'm teaching here at a college of pharmacy, and then 70% of my time I'm practicing as an |
| 1:18.4 | internal medicine pharmacist at Advocate Lutheran General Hospital. Wonderful. And, you know, |
| 1:23.4 | as we mentioned, today's episode focuses on the 2026 early management of acute ischemic stroke |
| 1:29.3 | guidelines. |
| 1:30.2 | And the last update was 2019. |
| 1:32.2 | So we're now seven years since our last update. |
| 1:35.2 | So probably time for a new document to come out. |
| 1:38.6 | Right. |
| 1:39.1 | And new and longer. |
| 1:41.2 | So there is like 119 pages. |
| 1:43.3 | Obviously, we're not going to cover all of it, but we have a |
| 1:45.7 | plan. And the plan is a five-prong approach. We're going to answer or focus on five sections. |
... |
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