back to US directory
us clinical guidance

Stroke and transient ischemic attack

US emergency recognition and current acute ischemic-stroke and secondary-prevention priorities for stroke and TIA.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team · Clinical editorial review · reviewed 2026-08-20 · due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adults with sudden focal neurologic symptoms suggesting stroke or TIA, plus early post-event secondary prevention. The 2026 acute source focuses on ischemic stroke; suspected intracerebral or subarachnoid hemorrhage follows separate AHA/ASA pathways. Pediatric ischemic-stroke recommendations exist in the full 2026 source but are not summarized here.
sources for this section:AHA/ASA stroke 2026AHA/ASA 2021

The Bottom Line

  • Treat new stroke symptoms as time critical: activate emergency medical services and a stroke system rather than arranging routine outpatient review.
  • The 2026 guideline supports system-specific transport decisions, expanded use of tenecteplase within 4.5 hours for eligible patients, and broader endovascular-thrombectomy eligibility selected by imaging and clinical criteria.
  • Do not delay reperfusion evaluation for avoidable nonessential testing; use a stroke-capable protocol to establish hemorrhage, vessel occlusion, time last known well and treatment eligibility.
  • After ischemic stroke or TIA, define the likely etiology because antithrombotic, carotid, cardiac and risk-factor strategies depend on stroke subtype.
  • Long-term dual antiplatelet therapy is not recommended for routine secondary prevention; short-term dual therapy is reserved for specific early minor-stroke, high-risk-TIA or severe symptomatic intracranial-stenosis groups.
sources for this section:AHA/ASA stroke 2026AHA/ASA 2021

Practical clinical workflow

1
Record last-known-well time, neurologic deficit, glucose, vital signs, anticoagulant exposure and emergency contraindications while activating EMS or the stroke team.
2
Perform immediate brain imaging and indicated vascular imaging within the local stroke protocol; determine intravenous-thrombolysis and thrombectomy eligibility without avoidable delay.
3
Monitor swallowing, temperature, oxygenation, glucose, blood pressure, neurologic change, hemorrhagic transformation and post-reperfusion complications in the appropriate setting.
4
Complete an etiologic work-up for secondary prevention, including vascular and cardiac evaluation guided by the presentation; consider rhythm monitoring for occult AF when no other cause is found.
5
Create a cause-specific plan for antithrombotic therapy, blood pressure, lipids, diabetes, tobacco, activity, rehabilitation and rapid follow-up.
sources for this section:AHA/ASA stroke 2026AHA/ASA 2021

Safety boundaries and escalation

  • Do not give antithrombotic or blood-pressure treatment by a generic outpatient algorithm before hemorrhage and reperfusion context are known.
  • The 2026 guideline does not recommend intensive glucose control to 80–130 mg/dL to improve acute outcome and warns of severe hypoglycemia.
  • Intensive systolic lowering below 140 mm Hg after thrombolysis or thrombectomy is not a default and may cause harm after thrombectomy; use the complete acute protocol.
  • Recurrent deficit, decreasing consciousness, severe headache, vomiting, seizure or new cardiorespiratory instability demands immediate reassessment.
sources for this section:AHA/ASA stroke 2026AHA/ASA 2021

Localization

Use the local US EMS destination plan, stroke-center capabilities and 2026 AHA/ASA eligibility criteria. State EMS protocols and transfer agreements determine real-world routing.
sources for this section:AHA/ASA stroke 2026AHA/ASA 2021

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. American Heart Association and American Stroke Association2026 Guideline for the Early Management of Patients With Acute Ischemic StrokeDOI 10.1161/STR.0000000000000513 · published 2026-01-26 · accessed 2026-08-20
    view source
  2. American Heart Association and American Stroke Association2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic AttackDOI 10.1161/STR.0000000000000375 · published 2021-05-24 · accessed 2026-08-20
    view source
continue the learning

From guidance to deliberate practice and evidence

Choose what happens next. iatroX can carry this page's jurisdiction, source-check date and released version into an editable learning record, support your reflection, or let you browse the regional question bank while keeping this topic visible. No action records completion, starts a session or awards CPD/CME credit automatically.

Add this guidance review to CPD/CMEOpen an editable learning-log record with this page’s provenance attached. You confirm the activity, time, reflection and mappings.Reflect on this with TutorUse optional prompts to consider what you learned and what—if anything—you may change. Suggestions are never inserted automatically.Browse the US question bankKeep this guidance topic in view, then choose your exam and filters. No session starts automatically.
Found a source update or regional discrepancy? Tell the iatroX editorial team.