S2 Ep97: Inside the New Consensus Recommendations for Acute Stroke Care

In this episode of Mind the Meds, host Erica Marini, PharmD, opens with the month's neurology pharmacy news:

• Novartis and Bristol Myers Squibb paused CAR T-cell trials in autoimmune diseases, including myasthenia gravis and multiple sclerosis, after safety concerns.
• FDA approvals included tavapadon (Juvmo; AbbVie), a selective D1/D5 dopamine agonist for Parkinson disease; apitegromab (Isembyld; Scholar Rock), an add-on myostatin inhibitor for spinal muscular atrophy; and levacetylleucine (Aqneursa; IntraBio Inc) for ataxia-telangiectasia.
• FDA also granted priority review to satralizumab (Genentech) for relapsing myelin oligodendrocyte glycoprotein antibody–associated disease. Currently, it is approved for anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder under the brand name Enspryng.
• Marini closes the segment with positive results for ulefnersen (Ionis Pharmaceuticals, Otsuka Pharmaceutical) in FUS-ALS in the phase 3 FUSION trial (NCT04768972) and for atogepant (Qulipta; AbbVie) in menstrual migraine prevention.

Marini is then joined by Caitlin S. Brown, PharmD, MPH, BCCCP, FCCM, FCCP, associate professor of pharmacy and emergency medicine at Mayo Clinic; and Brian Gilbert PharmD, MBA, FCCM, FNCS, FCCP, FASHP, FKCHP, a former emergency medicine clinical pharmacy specialist. Both are authors of the consensus recommendations on integrating clinical pharmacists into the acute stroke care team, published in the Journal of the American College of Clinical Pharmacy.1 The project grew out of the authors’ systematic reviews on pharmacist involvement in ischemic and hemorrhagic stroke. Their panel brought together emergency medicine and neurocritical care pharmacists from academic and community settings, emergency physicians, a neurologist, a librarian, and a statistician. The recommendations were endorsed by the American College of Clinical Pharmacy, the Neurocritical Care Society, the Society for Academic Emergency Medicine, and the Society of Critical Care Medicine, and affirmed by the American Academy of Neurology. Gilbert notes that this multidisciplinary support gives pharmacy leaders evidence they can bring to administrators when making the case for new full-time equivalent positions.

Brown and Gilbert walk through the evidence behind both recommendations. Across 10 studies in acute ischemic stroke, pharmacist involvement cut time to thrombolytic administration by about 15 minutes and helped teams meet 45- and 60-minute door-to-needle goals more often. In 6 hemorrhagic stroke studies, pharmacist involvement shortened time to reversal agent administration. The evidence is mostly low-quality retrospective data, and there are no functional outcomes data yet, so the authors relied on time-based surrogate end points. They explain that their hope is future research will capture the full range of pharmacist interventions, that telestroke services will bring pharmacists in to support rural hospitals, and that later American Heart Association (AHA) guidelines will specifically name pharmacists as members of the stroke team.

The episode ends with a look back at the January 2026 AHA ischemic stroke guidelines. Most centers had already switched to tenecteplase (TNKase; Genentech), and the guests say the bigger questions now are dosing strategy and whether to keep alteplase (Activase; Genentech) on formulary. They also discuss the extended thrombolysis window of up to 9 hours for patients with favorable imaging, which they expect to spread slowly outside academic centers. Other topics include the new guidance on alteplase for pediatric stroke, which both guests have given only once, and the caution against lowering blood pressure too far after reperfusion.

REFERENCE
Gilbert BW, Brown CS, Acquisto NM, et al. Consensus recommendations for clinical pharmacist integration into the acute stroke care team: Endorsed by the American College of Clinical Pharmacy, Neurocritical Care Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine, and affirmed by the American Academy of Neurology. J Am Coll Clin Pharm. 2026;9(7):e70246. doi:10.1002/jac5.70246