What’s New

The Ischemic Stroke and Transient Ischemic Attack (TIA) - Diagnosis and Acute Management guideline provides recommendations for the early recognition, assessment and acute management of ischemic stroke and transient ischemic attack (TIA) in adults ≥19 years old. Primary prevention, cerebral venous thrombosis, and hemorrhagic, pediatric, and pregnancy-related strokes are out of scope.

Key Recommendations

• NEW Treat suspected TIA or minor stroke presenting <48 hr as a medical emergency because stroke recurrence and/or progression is highest within this period.
• NEW Perform neuroimaging (non-contrast CT brain and non-invasive CTA arch to vertex) in all patients with suspected stroke/TIA, regardless of timing or persistence/resolution of symptoms.
• NEW Triage patients based on type of symptoms and time since onset (woke up with symptoms, <6 hr, 6–48 hr, >48 hr–2 weeks, >2 weeks) to determine the urgency of transport, neuroimaging, and specialist referral. Imaging is essential for assessing eligibility for reperfusion therapy (generally feasible within first 24 hr), and risk stratification.
• NEW Direct all patients with symptom onset <48 hr to a neuroimaging-capable ED, even if symptoms have resolved.
  • If symptoms are ongoing and onset <24 hr, contact 911 to activate stroke protocols to expedite imaging and assess eligibility for reperfusion therapy.
  • If symptoms have fully resolved OR onset is 24–48 hr, personal transport to nearest ED is an option. Alert ED about incoming patient. Patients should not drive themselves.
• NEW Consult with a stroke specialist (on-site or via Patient Transport Network) for urgent diagnostic and management decisions, including eligibility for reperfusion therapy (thrombolysis and/or endovascular therapy) and/or antithrombotic therapy (antiplatelet therapy [APT] or oral anticoagulant).
• NEW Initiate single APT prior to outpatient imaging in patients whose symptoms occurred >2 weeks ago and have now resolved. Consult with stroke specialist first if there is concern for high risk of intracranial hemorrhage.
• NEW Assess the risk of stroke within first week after a TIA by using the Canadian TIA Score.
• Urgently refer patients with symptomatic extracranial carotid artery stenosis (50–99% stenosis) to stroke prevention clinic and vascular surgery for potential carotid revascularization (surgery or stenting) to be performed ideally within 14 days.
• NEW Aim to admit patients to an acute stroke unit (i.e., a specialized, geographically defined hospital unit dedicated to the management of patients with stroke).

The Chronic Kidney Disease – Diagnosis and Management guideline provides recommendations for the investigation, evaluation, and management of adults at risk of/or with known chronic kidney disease (CKD).

Key Recommendations

• Screen high-risk patients (e.g., diabetes, hypertension, cardiovascular disease, family history, and those with a history of acute kidney injury) using estimated Glomerular Filtration Rate (eGFR) and urine Albumin-Creatinine Ratio (ACR). Confirm abnormal test results with a repeat measurement and obtain urinalysis (microscopic).
• Determine likely cause of kidney disease where possible. This has important implications for determining risk of End Stage Kidney Disease (ESKD)/Kidney Failure and other complications.
• Use disease modifying drugs to control hypertension and proteinuria that prevent or postpone kidney function decline.
• All patients with CKD: Initiate an ACE inhibitor (ACE-I) or angiotensin receptor blocker (ARB).
• [NEW] Patients with CKD and uACR ≥20 mg/mmol: In addition to ACE-I/ARB, start a sodium-glucose cotransporter 2 inhibitor (SGLT2i), unless contraindicated.
• [NEW] Patients with CKD and heart failure: In addition to ACE-I/ARB, start a SGLT2i, unless contraindicated.
• [NEW] Patients with CKD and type 2 diabetes: In addition to ACE-I/ARB and SGLT2i, include a non-steroidal mineralocorticoid receptor antagonist (ns-MRA) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA) to optimize renal and cardiovascular outcomes.
• Prescribe statins for CKD patients ≥ 50 yrs and for those 18-49 yrs with cardiovascular risk factors.
• Hold ACE-I, ARB, SGLT2i, and diuretics if patient has acute illness with dehydration, with a plan to restart.
• To assist in determining the need for and timing of referral, obtain advice from local internists, nephrologists or RACE.

Revisions to the Cervical Cancer Prevention and Screening Guideline to reflect changes in the BC Cancer screening program as well as HPV9 vaccine dose schedule recommendations and Immunize BC program eligibility.