From the Guidelines
For treating a Transient Ischemic Attack (TIA), immediate action is crucial to prevent a full-blown stroke.
Key Components of TIA Protocol
- Emergency Evaluation: Patients should be evaluated in an emergency setting as soon as possible, ideally within 60 minutes of symptom onset 1.
- Antiplatelet Therapy: Initiate aspirin 325 mg orally as soon as possible, followed by a maintenance dose of 81-100 mg daily. Alternatively, clopidogrel 75 mg daily can be used in patients allergic to aspirin 1.
- Anticoagulation: For patients with atrial fibrillation, initiate anticoagulation with a medication such as apixaban 5 mg twice daily, rivaroxaban 15 mg daily for 21 days then 20 mg daily, or dabigatran 150 mg twice daily 1.
- Statins: Initiate atorvastatin 80 mg daily to reduce the risk of recurrent stroke, as statin therapy is recommended for most people after atherothromboembolic TIA 1.
- Blood Pressure Management: Control blood pressure according to guidelines, aiming for a target systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Blood pressure-lowering medication should be started unless the patient has symptomatic hypotension, typically within 7 to 14 days after the TIA event 1.
- Imaging and Diagnostic Tests: Perform a non-contrast computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain, as well as carotid ultrasound, echocardiogram, and electrocardiogram (ECG) as needed 1.
- Lifestyle Modifications: Counsel patients on smoking cessation, healthy diet, regular exercise, and stress reduction. Encourage patients with a body mass index (BMI) greater than 25 to commence graduated lifestyle change aimed at weight reduction 1.
Close monitoring and follow-up with a neurologist or primary care physician are essential to adjust the treatment plan as needed and prevent future strokes. The management of TIA should also include the treatment of risk factors such as diabetes, with fasting blood glucose levels less than 126mg/dl (7mmol/L) recommended, and the management of cholesterol levels, aiming for an LDL level less than 100mg/dl 1.
From the Research
Protocol for Treating Transient Ischemic Attack (TIA)
The protocol for treating TIA involves rapid evaluation and immediate treatment to reduce the risk of stroke. Key aspects of the protocol include:
- Early risk stratification using ABCD2 scores to predict the risk of ischemic stroke occurring after TIA 2, 3
- Urgent referral to a specialist service for rapid assessment, preventive care, and treatment 2, 4, 5
- Immediate starting of antiplatelet therapy in patients with non-cardioembolic TIA or oral anticoagulant therapy in patients with cardioembolic TIA within 24 hours 2
- Use of aspirin, clopidogrel, or the combination of aspirin and extended-release dipyridamole as acceptable options for initial therapy in patients with TIA 6
- Comprehensive management of lifestyle, hypertension, diabetes mellitus, dyslipidemia, and other atherosclerotic diseases to prevent subsequent stroke 3
- Carotid endarterectomy and endovascular intervention for treating symptomatic patients with significant stenosis of the internal carotid artery (ICA) 3
Diagnostic Tests
Diagnostic tests used to evaluate TIA patients include:
- Computed tomography (CT)/CT angiography (CTA) 2
- Magnetic resonance imaging (MRI)/MR angiography (MRA) 2, 3
- Carotid ultrasonography to evaluate the degree of stenosis, plaque properties, and flow velocity of ICA lesions 3
- Diffusion-weighted imaging (DWI)-MRI to understand the mechanism of TIA and cerebral circulation 3
- Transesophageal echocardiography to detect aortogenic sources of emboli 3
Timing of Medical Attention
The timing of medical attention is crucial in TIA treatment, with studies highlighting the importance of seeking medical attention urgently for suspected TIAs 5. Factors that affect how quickly patients with TIAs seek medical attention include: