From the Guidelines
Patients who have experienced a Transient Ischemic Attack (TIA) should be immediately prescribed daily long-term antiplatelet therapy to prevent further vascular events, with the combination of aspirin and sustained-release dipyridamole being a reasonable first-choice option 1. The management of TIA is crucial in preventing subsequent strokes and other vascular events. According to the guidelines, antiplatelet therapy is the cornerstone of treatment for noncardioembolic TIA.
- The combination of aspirin (50mg) and sustained-release dipyridamole (200mg twice daily) is recommended as a first-choice option for patients with TIA to reduce the risk of stroke 1.
- Clopidogrel may be considered as an alternative, especially in patients who are intolerant to aspirin or have experienced a TIA while on aspirin therapy 1.
- Oral anticoagulation is not recommended for noncardioembolic TIA, as the risk of cerebral hemorrhagic complications outweighs the potential benefits 1. In contrast, patients with cardioembolic TIA, such as those with atrial fibrillation, should be treated with long-term oral anticoagulation, with a target international normalized ratio (INR) of 2.5 (range, 2.0-3.0) 1.
- Aspirin or clopidogrel may be considered in patients with cardioembolic TIA who are intolerant to oral anticoagulation or have a high risk of bleeding 1. It is essential to note that the management of TIA should be individualized, taking into account the patient's underlying risk factors, medical history, and potential contraindications to certain medications.
- A thorough evaluation, including imaging studies and laboratory tests, should be performed to determine the underlying cause of the TIA and to guide treatment decisions 1.
From the Research
Definition and Diagnosis of TIA
- TIA is defined as an episode of neurological deficit with sudden onset, caused by focal cerebral or retinal ischemia lasting less than 24 hours 2
- A tissue-based definition has been proposed, but its application is challenging and requires magnetic resonance imaging 2
- Diagnosis is often based on history provided by the patient, and interobserver agreement between physicians is only fair 2
Risk of Stroke after TIA
- TIA is a harbinger of ischemic stroke, and immediate acute care and treatment can decrease the risk of stroke substantially 2, 3
- The risk of recurrent stroke in patients who have suffered a prior stroke or TIA is significant, and early intervention is crucial 3
Treatment and Management of TIA
- Antithrombotic therapy, statins, blood pressure lowering medications, and carotid surgery may be indicated based on diagnostic findings 2
- Aspirin is widely used for the prevention of recurrent stroke in patients with TIA, but other antithrombotic regimens such as clopidogrel and combination of aspirin and extended-release dipyridamole may be more effective 4
- Dual antiplatelet therapy may reduce the risk of recurrent ischemic events in higher risk patients, while anticoagulation is recommended in patients with a cardioembolic source 5
Diagnostic Procedures and Imaging
- Diagnostic procedures include imaging of the brain and neck vessels, ECG and cardiac rhythm monitoring, and blood pressure measuring 2
- Non-contrast computed tomography (CT) has limited utility, but advanced cerebral imaging such as CT angiography or Doppler ultrasound can be used to evaluate for minor or subclinical stroke 5