Materiały źródłowe

• #1 An Integrative and Comprehensive Approach to Transient Ischemic Attacks

  https://www.rupahealth.com/post/an-integrative-and-comprehensive-approach-to-transient-ischemic-attacks

  Medications prescribed often include antiplatelets, statins, and antihypertensives to help manage clotting risk and support healthy cholesterol and blood pressure levels. […] Studies have shown that early interventions post-TIA may help mitigate the risk of future stroke by 80-90%. […] Because, in most cases, TIA is a consequence of atherosclerosis, appropriate treatment involves using various modalities that support cardiovascular health to help manage blood clotting and enhance blood and oxygen supply to the brain. […] A heart-healthy diet is crucial in supporting the management of TIA risk factors because it helps manage key risk factors. […] By focusing on nutrient-dense foods, the diet can help support healthy blood pressure, manage LDL („bad”) cholesterol, improve insulin sensitivity, and maintain a healthy body weight.

• #2 Transient Ischemic Attack – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459143/

  The main aim of treatment of TIA is to decrease the risk of subsequent stroke or TIA. Early treatment after a TIA can significantly reduce the risk of early stroke. […] Management of TIAs should focus on treating underlying etiologies. […] Studies in the new millennium already confirmed the importance of expedited evaluation and treatment plus the polytherapy approach. The EXPRESS study in the UK has shown the importance of early intervention versus regular treatment by reducing 80% of the stroke risk. […] More recent studies in China (CHANCE trial) and the multinational POINTE trial also confirmed dual antiplatelet with aspirin and clopidogrel for 3 weeks to 1 month, followed by a single antiplatelet agent, is the best scheme for antiplatelet therapy. […] The other part of the treatment will depend on the underlying etiology of the TIA. Revascularization is recommended for symptomatic cervical internal carotid artery stenosis of 70% or higher. Carotid endarterectomy may have a slight benefit-to-risk ratio compared with endovascular intervention and stenting. […] Oral anticoagulation is indicated for patients with atrial fibrillation or other sources of cardioembolic sources of TIA.

• #3 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics/print

  Transient ischemic attack (TIA) is the medical term for neurologic symptoms that signal dysfunction of the brain, such as weakness or numbness, which begin suddenly and resolve rapidly and completely. […] It is important to get medical help right away if you think you may be having a TIA or a stroke. […] The optimal treatment of a TIA depends upon the presumed cause of the TIA, how much time has passed since the first TIA symptoms occurred, and the person’s underlying medical problems. […] The goal of treatment is to reduce the risk of having a stroke. There are several types of treatment: Treating risk factors, such as high blood pressure; Antiplatelet therapy; Statin therapy to lower LDL cholesterol levels; Anticoagulant therapy; Revascularization (a procedure to restore blood flow by opening up a partial blockage in an artery).

• #4 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Transient ischemic attack TREATMENT […] The optimal treatment of a TIA depends upon the presumed cause of the TIA, how much time has passed since the first TIA symptoms occurred, and the person’s underlying medical problems. The goal of treatment is to reduce the risk of having a stroke. There are several types of treatment: […] Treating risk factors, such as high blood pressure […] Antiplatelet therapy […] Statin therapy to lower LDL cholesterol levels […] Anticoagulant therapy […] Revascularization (a procedure to restore blood flow by opening up a partial blockage in an artery) […] These are discussed in more detail below. […] Treating risk factors — Anyone who has had a TIA has an increased risk of having another TIA or a stroke in the future, especially within the first 48 hours after the TIA. Treatment can significantly reduce risk in the long term. In addition, lifestyle changes and careful management of underlying medical problems can help to reduce the risk of future strokes. Depending on the person’s situation, these may include the following: […] Treatment of high blood pressure […] Controlling diabetes […] Stopping smoking […] Treating high cholesterol and lipids.

• #5 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Antiplatelet therapy — Platelets are a type of cell that circulate in the blood and normally help the blood to clot. In TIA, platelets clump together and form clots inside narrowed arteries, temporarily blocking blood flow in the brain. Antiplatelet therapy means medications that can help prevent new clots from developing. Expert guidelines recommend that most patients with a TIA and no contraindication start taking an antiplatelet medication to reduce the risk of subsequent stroke. The most commonly used options are aspirin and clopidogrel. In some cases, two antiplatelet medicines are used together for a few weeks after a TIA, as discussed below. […] An exception is that people who have a TIA related to an irregular heart rhythm (atrial fibrillation) should be treated with anticoagulation.

• #6 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anti-platelet-therapy-in-ischemic-stroke-and-tia

  All patients with acute ischemic stroke or transient ischemic attack not already on an antiplatelet agent should be treated with at least 160 mg of acetylsalicylic acid immediately as a one-time loading dose after brain imaging has excluded intracranial hemorrhage [Evidence Level A]. […] Antiplatelet therapy should be started as soon as possible after brain imaging has excluded hemorrhage, within 24 hours of symptom onset (ideally within 12 hours) [Evidence Level B]. […] For transient ischemic attack or minor ischemic stroke patients who are being discharged from the emergency department, antiplatelet therapy should be started prior to discharge [Evidence Level C]. […] For patients with ischemic stroke or transient ischemic attack, antiplatelet therapy is recommended for long-term secondary stroke prevention to reduce the risk of recurrent stroke and other vascular events unless there is an indication for anticoagulant therapy [Evidence Level A].

• #7 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Once your healthcare professional learns the cause of the transient ischemic attack, the goal of treatment is to correct the issue and prevent a stroke. You may need medicines to prevent blood clots. Or you might need surgery. […] Several medicines may lower the risk of stroke after a TIA. Your healthcare professional recommends a medicine based on what caused the TIA, where it was located, its type and how bad the blockage was. Your healthcare professional may prescribe: […] Anti-platelet drugs. These medicines make a circulating blood cell called platelets less likely to stick together. […] Aspirin is the most commonly used anti-platelet medicine. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix).

• #8 Transient Ischemic Attacks: Part II. Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0401/p1681.html

  In most patients, aspirin in a dosage of 50 to 325 mg per day is the recommended initial agent for antiplatelet therapy. In patients who cannot tolerate aspirin, clopidogrel (Plavix) may be a good second choice; this agent currently is considered to be safer than ticlopidine (Ticlid). […] Aspirin therapy after a stroke or TIA reduces the long-term relative risk of stroke and increases the chance of a full recovery. The optimal aspirin dosage for use in the prevention of stroke or TIA remains controversial, but a range of 50 to 325 mg per day has been recommended. […] Anticoagulation therapy is appropriate in patients with high-risk cardioembolic conditions. These conditions include atrial fibrillation, a known cardioembolic source (confirmed thrombus), or a suspected cardioembolic source (recent large myocardial infarction, mechanical valve, dilated cardiomyopathy, rheumatic mitral valve stenosis). […] There is also evidence that warfarin (Coumadin) is useful for secondary prevention of stroke, as well as primary prevention.

• #9 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Aspirin and clopidogrel may be prescribed together for about a month after the TIA. […] Sometimes both medicines are taken together for a longer period. This may be recommended when the cause of the TIA is a narrowing of a blood vessel in the head. […] When there’s a serious block of a major artery, the medicine cilostazol may be prescribed with aspirin or clopidogrel. […] Alternatively, your healthcare professional may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke. […] Your healthcare professional also may consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce blood clotting. […] Anticoagulants. These medicines include heparin and warfarin (Jantoven). They lower the risk of blood clots by affecting clotting-system proteins instead of platelet function.

• #10 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anti-platelet-therapy-in-ischemic-stroke-and-tia

  A single loading dose of clopidogrel (either 300 mg (CHANCE trial) or 600 mg (POINT trial)) and acetylsalicylic acid (160 mg – 325 mg) should be administered at the start of treatment [Evidence Level A]. […] Another reasonable short-term dual antiplatelet treatment option is the combination of daily low-dose acetylsalicylic acid plus ticagrelor (180 mg loading dose, followed by 90 mg bid) for 30 days [Evidence Level B]. […] For patients with a recent stroke or transient ischemic attack due to symptomatic intracranial atherosclerotic stenosis of 70-99%, and a low estimated bleeding risk, the SAMMPRIS protocol should be considered, which includes dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) for the first 3 months, typically followed by antiplatelet monotherapy thereafter, in addition to intensive lipid-lowering therapy with high-dose statin, blood pressure treatment, and structured lifestyle modification addressing smoking cessation, exercise and diet [Evidence Level B].

• #11 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Aspirin — Daily aspirin can help to reduce the risk of a future stroke. Aspirin typically costs far less than other antiplatelet medications and is well tolerated. […] Clopidogrel — Clopidogrel (brand name: Plavix) is an antiplatelet medication that is also used in patients after TIA to reduce the risk of stroke. […] Cilostazol — Cilostazol is another antiplatelet medication that reduces the risk of ischemic stroke after TIA. […] Ticagrelor — Ticagrelor is an antiplatelet medication that is sometimes used alone or in combination with aspirin after a TIA to reduce the risk of a stroke. […] Dipyridamole and aspirin — Dipyridamole is a medication that may be given after a TIA to reduce the risk of stroke. […] Short-term dual antiplatelet therapy — In some cases, „dual antiplatelet therapy” with two medications (eg, aspirin and clopidogrel, or aspirin and ticagrelor) is started immediately after a TIA and continued for 21 days or more, depending on the type of TIA.

• #12 Transient Ischemic Attack Medication: Antiplatelet Agents, Anticoagulants

  https://emedicine.medscape.com/article/1910519-medication

  Pharmacologic management for transient ischemic attacks (TIAs) is aimed at reducing both short-term and long-term risk of stroke. In view of the high short-term risk of stroke after TIA, antithrombotic therapy should be initiated as soon as intracranial hemorrhage has been ruled out. […] Combination aspirin-dipyridamole therapy has been shown to prevent cardiovascular events following TIAs. […] Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. […] Controlled therapeutic inhibition of blood clotting by means of appropriate drugs (ie, anticoagulants) is indicated for prevention of ischemic stroke in patients with risk factors for thromboembolism, such as atrial fibrillation. […] Warfarin interferes with hepatic synthesis of vitamin Kdependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders.

• #13 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Aspirin and clopidogrel may be prescribed together for about a month after the TIA. […] Sometimes both medicines are taken together for a longer period. This may be recommended when the cause of the TIA is a narrowing of a blood vessel in the head. […] When there’s a serious block of a major artery, the medicine cilostazol may be prescribed with aspirin or clopidogrel. […] Alternatively, your healthcare professional may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke. […] Your healthcare professional also may consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce blood clotting. […] Anticoagulants. These medicines include heparin and warfarin (Jantoven). They lower the risk of blood clots by affecting clotting-system proteins instead of platelet function.

• #14 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anti-platelet-therapy-in-ischemic-stroke-and-tia

  A single loading dose of clopidogrel (either 300 mg (CHANCE trial) or 600 mg (POINT trial)) and acetylsalicylic acid (160 mg – 325 mg) should be administered at the start of treatment [Evidence Level A]. […] Another reasonable short-term dual antiplatelet treatment option is the combination of daily low-dose acetylsalicylic acid plus ticagrelor (180 mg loading dose, followed by 90 mg bid) for 30 days [Evidence Level B]. […] For patients with a recent stroke or transient ischemic attack due to symptomatic intracranial atherosclerotic stenosis of 70-99%, and a low estimated bleeding risk, the SAMMPRIS protocol should be considered, which includes dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) for the first 3 months, typically followed by antiplatelet monotherapy thereafter, in addition to intensive lipid-lowering therapy with high-dose statin, blood pressure treatment, and structured lifestyle modification addressing smoking cessation, exercise and diet [Evidence Level B].

• #15 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Aspirin and clopidogrel may be prescribed together for about a month after the TIA. […] Sometimes both medicines are taken together for a longer period. This may be recommended when the cause of the TIA is a narrowing of a blood vessel in the head. […] When there’s a serious block of a major artery, the medicine cilostazol may be prescribed with aspirin or clopidogrel. […] Alternatively, your healthcare professional may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke. […] Your healthcare professional also may consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce blood clotting. […] Anticoagulants. These medicines include heparin and warfarin (Jantoven). They lower the risk of blood clots by affecting clotting-system proteins instead of platelet function.

• #16 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Aspirin — Daily aspirin can help to reduce the risk of a future stroke. Aspirin typically costs far less than other antiplatelet medications and is well tolerated. […] Clopidogrel — Clopidogrel (brand name: Plavix) is an antiplatelet medication that is also used in patients after TIA to reduce the risk of stroke. […] Cilostazol — Cilostazol is another antiplatelet medication that reduces the risk of ischemic stroke after TIA. […] Ticagrelor — Ticagrelor is an antiplatelet medication that is sometimes used alone or in combination with aspirin after a TIA to reduce the risk of a stroke. […] Dipyridamole and aspirin — Dipyridamole is a medication that may be given after a TIA to reduce the risk of stroke. […] Short-term dual antiplatelet therapy — In some cases, „dual antiplatelet therapy” with two medications (eg, aspirin and clopidogrel, or aspirin and ticagrelor) is started immediately after a TIA and continued for 21 days or more, depending on the type of TIA.

• #17 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Aspirin — Daily aspirin can help to reduce the risk of a future stroke. Aspirin typically costs far less than other antiplatelet medications and is well tolerated. […] Clopidogrel — Clopidogrel (brand name: Plavix) is an antiplatelet medication that is also used in patients after TIA to reduce the risk of stroke. […] Cilostazol — Cilostazol is another antiplatelet medication that reduces the risk of ischemic stroke after TIA. […] Ticagrelor — Ticagrelor is an antiplatelet medication that is sometimes used alone or in combination with aspirin after a TIA to reduce the risk of a stroke. […] Dipyridamole and aspirin — Dipyridamole is a medication that may be given after a TIA to reduce the risk of stroke. […] Short-term dual antiplatelet therapy — In some cases, „dual antiplatelet therapy” with two medications (eg, aspirin and clopidogrel, or aspirin and ticagrelor) is started immediately after a TIA and continued for 21 days or more, depending on the type of TIA.

• #18 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anti-platelet-therapy-in-ischemic-stroke-and-tia

  For long-term secondary stroke prevention, either acetylsalicylic acid (80 mg 325 mg daily), or clopidogrel (75 mg daily), or combined acetylsalicylic acid and extended-release dipyridamole (25mg/200 mg BID), are all appropriate treatment options and selection depends on patient factors or clinical circumstances [Evidence Level A]. […] For patients with an acute high-risk transient ischemic attack or minor ischemic stroke of non-cardioembolic origin (NIHSS 0-3), who are not at high bleeding risk, dual antiplatelet therapy is recommended with clopidogrel 75 mg daily plus acetylsalicylic acid 81 mg daily for a duration of 21 days after the event, followed by antiplatelet monotherapy thereafter (acetylsalicylic acid or clopidogrel alone) [Evidence Level A]. […] Dual antiplatelet therapy for longer than the first 21 days following a transient ischemic attack or minor stroke is not recommended unless there is a specific indication (e.g., arterial stent; symptomatic intracranial artery stenosis), due to an increased risk of bleeding without clear benefit beyond 21 days [Evidence Level B].

• #19 Transient Ischemic Attack – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459143/

  The main aim of treatment of TIA is to decrease the risk of subsequent stroke or TIA. Early treatment after a TIA can significantly reduce the risk of early stroke. […] Management of TIAs should focus on treating underlying etiologies. […] Studies in the new millennium already confirmed the importance of expedited evaluation and treatment plus the polytherapy approach. The EXPRESS study in the UK has shown the importance of early intervention versus regular treatment by reducing 80% of the stroke risk. […] More recent studies in China (CHANCE trial) and the multinational POINTE trial also confirmed dual antiplatelet with aspirin and clopidogrel for 3 weeks to 1 month, followed by a single antiplatelet agent, is the best scheme for antiplatelet therapy. […] The other part of the treatment will depend on the underlying etiology of the TIA. Revascularization is recommended for symptomatic cervical internal carotid artery stenosis of 70% or higher. Carotid endarterectomy may have a slight benefit-to-risk ratio compared with endovascular intervention and stenting. […] Oral anticoagulation is indicated for patients with atrial fibrillation or other sources of cardioembolic sources of TIA.

• #20 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anti-platelet-therapy-in-ischemic-stroke-and-tia

  For long-term secondary stroke prevention, either acetylsalicylic acid (80 mg 325 mg daily), or clopidogrel (75 mg daily), or combined acetylsalicylic acid and extended-release dipyridamole (25mg/200 mg BID), are all appropriate treatment options and selection depends on patient factors or clinical circumstances [Evidence Level A]. […] For patients with an acute high-risk transient ischemic attack or minor ischemic stroke of non-cardioembolic origin (NIHSS 0-3), who are not at high bleeding risk, dual antiplatelet therapy is recommended with clopidogrel 75 mg daily plus acetylsalicylic acid 81 mg daily for a duration of 21 days after the event, followed by antiplatelet monotherapy thereafter (acetylsalicylic acid or clopidogrel alone) [Evidence Level A]. […] Dual antiplatelet therapy for longer than the first 21 days following a transient ischemic attack or minor stroke is not recommended unless there is a specific indication (e.g., arterial stent; symptomatic intracranial artery stenosis), due to an increased risk of bleeding without clear benefit beyond 21 days [Evidence Level B].

• #21 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Aspirin and clopidogrel may be prescribed together for about a month after the TIA. […] Sometimes both medicines are taken together for a longer period. This may be recommended when the cause of the TIA is a narrowing of a blood vessel in the head. […] When there’s a serious block of a major artery, the medicine cilostazol may be prescribed with aspirin or clopidogrel. […] Alternatively, your healthcare professional may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke. […] Your healthcare professional also may consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce blood clotting. […] Anticoagulants. These medicines include heparin and warfarin (Jantoven). They lower the risk of blood clots by affecting clotting-system proteins instead of platelet function.

• #22 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anti-platelet-therapy-in-ischemic-stroke-and-tia

  A single loading dose of clopidogrel (either 300 mg (CHANCE trial) or 600 mg (POINT trial)) and acetylsalicylic acid (160 mg – 325 mg) should be administered at the start of treatment [Evidence Level A]. […] Another reasonable short-term dual antiplatelet treatment option is the combination of daily low-dose acetylsalicylic acid plus ticagrelor (180 mg loading dose, followed by 90 mg bid) for 30 days [Evidence Level B]. […] For patients with a recent stroke or transient ischemic attack due to symptomatic intracranial atherosclerotic stenosis of 70-99%, and a low estimated bleeding risk, the SAMMPRIS protocol should be considered, which includes dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) for the first 3 months, typically followed by antiplatelet monotherapy thereafter, in addition to intensive lipid-lowering therapy with high-dose statin, blood pressure treatment, and structured lifestyle modification addressing smoking cessation, exercise and diet [Evidence Level B].

• #23 Transient Ischemic Attack – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459143/

  The main aim of treatment of TIA is to decrease the risk of subsequent stroke or TIA. Early treatment after a TIA can significantly reduce the risk of early stroke. […] Management of TIAs should focus on treating underlying etiologies. […] Studies in the new millennium already confirmed the importance of expedited evaluation and treatment plus the polytherapy approach. The EXPRESS study in the UK has shown the importance of early intervention versus regular treatment by reducing 80% of the stroke risk. […] More recent studies in China (CHANCE trial) and the multinational POINTE trial also confirmed dual antiplatelet with aspirin and clopidogrel for 3 weeks to 1 month, followed by a single antiplatelet agent, is the best scheme for antiplatelet therapy. […] The other part of the treatment will depend on the underlying etiology of the TIA. Revascularization is recommended for symptomatic cervical internal carotid artery stenosis of 70% or higher. Carotid endarterectomy may have a slight benefit-to-risk ratio compared with endovascular intervention and stenting. […] Oral anticoagulation is indicated for patients with atrial fibrillation or other sources of cardioembolic sources of TIA.

• #24 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Anticoagulant therapy — Anticoagulants are often referred to as „blood thinners.” They work by decreasing the formation of blood clots. Anticoagulant therapy is usually recommended for selected people with an irregular heart rhythm (atrial fibrillation) who have had a TIA or are at risk for a TIA or stroke. […] Revascularization — Revascularization is the medical term for reestablishing blood flow to an area. In people who have had a TIA, revascularization usually refers to an invasive procedure that opens a partially blocked artery in the neck (the carotid artery), which reduces the risk of stroke. This procedure is called „carotid endarterectomy.”

• #25 Transient Ischemic Attack Treatment & Management: Approach Considerations, Patient Disposition, Management of Hypertension

  https://emedicine.medscape.com/article/1910519-treatment

  In view of the high short-term risk of stroke after TIA, antithrombotic therapy should be initiated as soon as intracranial hemorrhage has been ruled out. […] Antiplatelet agents, rather than oral anticoagulants, are recommended as initial therapy. Aspirin 50325 mg/day, a combination of aspirin and extended-release dipyridamole, and clopidogrel are all reasonable first-line options. […] In patients who have atrial fibrillation in association with a TIA, long-term anticoagulation with warfarin to a target international normalized ratio (INR) of 2-3 is typically recommended. […] Patients who have experienced a transient ischemic attack (TIA) may undergo closure of a patent foramen ovale (PFO). […] According to the AHA/ASA guidelines, optimal medical treatment for these patients includes antiplatelet and statin therapies, as well as risk factor modification.

• #26 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Aspirin and clopidogrel may be prescribed together for about a month after the TIA. […] Sometimes both medicines are taken together for a longer period. This may be recommended when the cause of the TIA is a narrowing of a blood vessel in the head. […] When there’s a serious block of a major artery, the medicine cilostazol may be prescribed with aspirin or clopidogrel. […] Alternatively, your healthcare professional may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke. […] Your healthcare professional also may consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce blood clotting. […] Anticoagulants. These medicines include heparin and warfarin (Jantoven). They lower the risk of blood clots by affecting clotting-system proteins instead of platelet function.

• #27 Transient Ischemic Attack Medication: Antiplatelet Agents, Anticoagulants

  https://emedicine.medscape.com/article/1910519-medication

  Pharmacologic management for transient ischemic attacks (TIAs) is aimed at reducing both short-term and long-term risk of stroke. In view of the high short-term risk of stroke after TIA, antithrombotic therapy should be initiated as soon as intracranial hemorrhage has been ruled out. […] Combination aspirin-dipyridamole therapy has been shown to prevent cardiovascular events following TIAs. […] Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. […] Controlled therapeutic inhibition of blood clotting by means of appropriate drugs (ie, anticoagulants) is indicated for prevention of ischemic stroke in patients with risk factors for thromboembolism, such as atrial fibrillation. […] Warfarin interferes with hepatic synthesis of vitamin Kdependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders.

• #28 Transient Ischemic Attack (TIA)

  https://www.webmd.com/stroke/what-to-know-about-a-transient-ischemic-attack-tia

  Anticoagulant drugs. Your doctor may prescribe one of these medications. They thin your blood, making it less likely to clot. Blood thinners are usually prescribed if you had a blood clot in your heart or have a condition known as atrial fibrillation (irregular heart rhythm). Anticoagulants include apixaban (Eliquis), dabigatran (Pradaxa), heparin, rivaroxaban (Xarelto), and warfarin (Coumadin, Jantoven). […] Statins. Statins are medications used for lowering cholesterol. Research has also shown that statins may help keep blood vessels healthy and hinder blood clotting. Statins include atorvastatin (Lipitor), fluvastin (Lescol XL), rosuvastatin (Crestor), and simvastatin (Zocor). […] Blood pressure medications. Your doctor may prescribe one of these medications, which help expand blood vessels and allow for better blood flow. There are several medications in this class, including calcium channel blockers like amlodipine (Norvasc), angiotensin-converting enzyme (ACE) inhibitors like benazepril (Lotensin), angiotensin II receptor blockers (ARBs) including candesartan (Atacand), and diuretics.

• #29 Transient ischemic attack: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000730.htm

  If you have had a TIA within the last 48 hours, you will likely be admitted to the hospital so that doctors can search for the cause and monitor you. […] High blood pressure, heart disease, diabetes, high cholesterol, and blood disorders will be treated as needed. You will be encouraged to make lifestyle changes to reduce your risk of further symptoms. Changes include quitting smoking, exercising more, and eating healthier foods. […] You may receive blood thinners, such as aspirin, heparin, warfarin (Coumadin), or direct acting oral anticoagulants (DOACs) to reduce blood clotting. Some people who have blocked neck arteries may need surgery (carotid endarterectomy). If you have an irregular heartbeat (atrial fibrillation) or other heart problems, you will be treated to avoid future complications.

• #30 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  Aspirin and clopidogrel may be prescribed together for about a month after the TIA. […] Sometimes both medicines are taken together for a longer period. This may be recommended when the cause of the TIA is a narrowing of a blood vessel in the head. […] When there’s a serious block of a major artery, the medicine cilostazol may be prescribed with aspirin or clopidogrel. […] Alternatively, your healthcare professional may prescribe ticagrelor (Brilinta) and aspirin for 30 days to decrease your risk of recurrent stroke. […] Your healthcare professional also may consider prescribing a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce blood clotting. […] Anticoagulants. These medicines include heparin and warfarin (Jantoven). They lower the risk of blood clots by affecting clotting-system proteins instead of platelet function.

• #31 Transient Ischemic Attack (TIA) Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/transient-ischemic-attack-tia

  A Transient Ischemic Attack (TIA), also known as Transient Cerebral Ischemia or mini-stroke, is an event in which blood flow to the brain is briefly blocked and then restored before lasting damage occurs. Surgical treatment of the underlying cause may prevent permanent damage. The most common treatment options are carotid endarterectomy (CEA) and carotid artery angioplasty and stenting (CAS). Our neurosurgeons are experienced in these, as well as less common surgical interventions. […] The goal of treatment is to prevent a stroke. The foundation of stroke prevention is usually a combination of medication and lifestyle changes. […] Surgery may also be required in certain cases, such as in patients with severely narrowed carotid arteries. […] The two main surgical treatments for carotid artery disease are carotid endarterectomy (CEA) and carotid artery angioplasty and stenting (CAS). In a CEA, a neurosurgeon opens the artery and physically removes the blockage. In a CAS, a neurosurgeon inserts an instrument that widens the artery and props it open.

• #32 Transient ischemic attack – Wikipedia

  https://en.wikipedia.org/wiki/Transient_ischemic_attack

  There is inconsistent evidence regarding the effect of LDL-cholesterol levels on stroke risk after TIA. […] Diabetes mellitus increases the risk of ischemic stroke by 1.5-3.7 times, and may account for at least 8% of first ischemic strokes. […] If the TIA affects an area that is supplied by the carotid arteries, a carotid ultrasound scan may demonstrate stenosis, or narrowing, of the carotid artery. […] For people with extra-cranial carotid stenosis, if 70-99% of the carotid artery is clogged, carotid endarterectomy can decrease the five-year risk of ischemic stroke by approximately half. […] For those with extra-cranial stenosis between 50 and 69%, carotid endarterectomy decreases the 5-year risk of ischemic stroke by about 16%. […] For those with extra-cranial stenosis less than 50%, carotid endarterectomy does not reduce stroke risk and may, in some cases, increase it.

• #33 Transient ischemic attack – Wikipedia

  https://en.wikipedia.org/wiki/Transient_ischemic_attack

  In carotid endarterectomy, a surgeon makes an incision in the neck, opens up the carotid artery, and removes the plaque occluding the blood vessel. […] Carotid artery stenting is a less invasive alternative to carotid endarterectomy for people with extra-cranial carotid artery stenosis. […] People who undergo carotid endarterectomy or carotid artery stenting for stroke prevention are medically managed with antiplatelets, statins, and other interventions as well.

• #34 Transient Ischemic Attack: Part II. Risk Factor Modification and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0915/p527.html

  Following a transient ischemic attack (TIA), the focus of treatment should be prevention of future stroke. […] Antiplatelet agents are recommended for patients with a history of noncardioembolic TIA or stroke to prevent a subsequent stroke. […] Statins are recommended for patients who have a history of TIA and a low-density lipoprotein cholesterol level of 100 mg per dL (2.59 mmol per L) or more. […] For patients who have had a recent TIA or ischemic stroke and have ipsilateral stenosis, carotid endarterectomy is recommended if stenosis is 70 to 99 percent and perioperative morbidity and mortality are estimated to be less than 6 percent. […] Carotid artery atherosclerosis or stenosis is a well-established etiology of embolic stroke. […] For patients who have had a TIA or ischemic stroke within the past six months and have ipsilateral stenosis, carotid endarterectomy is recommended if stenosis is 70 to 99 percent and perioperative morbidity and mortality are estimated to be less than 6 percent.

• #35 Transient ischemic attack (TIA) | STROKE MANUAL

  https://www.stroke-manual.com/transient-ischemic-attack-tia/

  immediately start multimodal therapeutic intervention […] treatment can significantly reduce the risk of recurrent stroke or TIA (by 80%) EXPRESS trial […] antiplatelet drugs(aspirin, clopidogrel, or ticagrelor) in the prevention of non-cardioembolic TIA […] anticoagulation is the preferred treatment forcardioembolic TIA or stroke(due to atrial fibrillation or other embolic sources) […] carotid endarterectomy (CEA)should be performed within2-14 days if significant carotid stenosis is detected […] carotid angioplasty with stenting (CAS) alternative for patients at high surgical risk or with contraindications to CEA

• #36 Transient Ischemic Attack (TIA)

  https://www.webmd.com/stroke/what-to-know-about-a-transient-ischemic-attack-tia

  Your doctor may also recommend an endovascular procedure (which means inside a blood vessel). With these, a narrow tube is inserted into a vessel through a small cut, usually in your groin. These procedures include: Thrombectomy, performed to remove a blood clot; Stent, a mesh device put into a narrowed blood vessel to keep it open; Angioplasty, where a catheter is used to place a balloon in a vessel to widen it. […] If medication and endovascular procedures aren’t enough, your doctor may recommend surgery. If one of the carotid arteries in your neck is narrowed or blocked, your doctor may perform surgery to clear it out and restore normal blood flow. One option is an operation called a carotid endarterectomy, where your doctor opens up your carotid artery, scrapes out the plaque, and closes it back up.

• #37 Transient ischemic attack – Wikipedia

  https://en.wikipedia.org/wiki/Transient_ischemic_attack

  In carotid endarterectomy, a surgeon makes an incision in the neck, opens up the carotid artery, and removes the plaque occluding the blood vessel. […] Carotid artery stenting is a less invasive alternative to carotid endarterectomy for people with extra-cranial carotid artery stenosis. […] People who undergo carotid endarterectomy or carotid artery stenting for stroke prevention are medically managed with antiplatelets, statins, and other interventions as well.

• #38 Transient ischemic attack (TIA) | STROKE MANUAL

  https://www.stroke-manual.com/transient-ischemic-attack-tia/

  immediately start multimodal therapeutic intervention […] treatment can significantly reduce the risk of recurrent stroke or TIA (by 80%) EXPRESS trial […] antiplatelet drugs(aspirin, clopidogrel, or ticagrelor) in the prevention of non-cardioembolic TIA […] anticoagulation is the preferred treatment forcardioembolic TIA or stroke(due to atrial fibrillation or other embolic sources) […] carotid endarterectomy (CEA)should be performed within2-14 days if significant carotid stenosis is detected […] carotid angioplasty with stenting (CAS) alternative for patients at high surgical risk or with contraindications to CEA

• #39 Patient education: Transient ischemic attack (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics

  Transient ischemic attack TREATMENT […] The optimal treatment of a TIA depends upon the presumed cause of the TIA, how much time has passed since the first TIA symptoms occurred, and the person’s underlying medical problems. The goal of treatment is to reduce the risk of having a stroke. There are several types of treatment: […] Treating risk factors, such as high blood pressure […] Antiplatelet therapy […] Statin therapy to lower LDL cholesterol levels […] Anticoagulant therapy […] Revascularization (a procedure to restore blood flow by opening up a partial blockage in an artery) […] These are discussed in more detail below. […] Treating risk factors — Anyone who has had a TIA has an increased risk of having another TIA or a stroke in the future, especially within the first 48 hours after the TIA. Treatment can significantly reduce risk in the long term. In addition, lifestyle changes and careful management of underlying medical problems can help to reduce the risk of future strokes. Depending on the person’s situation, these may include the following: […] Treatment of high blood pressure […] Controlling diabetes […] Stopping smoking […] Treating high cholesterol and lipids.

• #40 Transient ischemic attack (TIA) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/symptoms-causes/syc-20355679

  If you think you’re having or have had a transient ischemic attack, get medical attention right away. TIAs most often occur hours or days before a stroke. Being evaluated quickly means healthcare professionals can pinpoint potential treatable conditions. Treating those conditions may help you prevent a stroke. […] Knowing your risk factors and living healthfully are the best things you can do to prevent a transient ischemic attack. A healthy lifestyle includes getting regular medical checkups. […] Don’t smoke. Stopping smoking reduces your risk of a TIA or a stroke. […] Limit cholesterol and fat. Cutting back on cholesterol and fat, especially saturated fat and trans fat, in your diet may reduce buildup of plaques in the arteries. […] Exercise regularly. If you have high blood pressure, regular exercise is one of the few ways you can lower your blood pressure without medicines. […] Control diabetes. You can manage diabetes and high blood pressure with diet, exercise, weight control and, when necessary, medicine.

• #41 GGC Medicines – Secondary prevention of Stroke and Transient Ischaemic Attack (TIA)

  https://handbook.ggcmedicines.org.uk/guidelines/cardiovascular-system/secondary-prevention-of-stroke-and-transient-ischaemic-attack-tia/

  If the patient is allergic or intolerant to clopidogrel, then prescribe combination therapy: Aspirin oral 300mg each day for 14 days or until hospital discharge, then reduce to aspirin oral 75 mg each day. […] Patients will usually start oral anticoagulants 10 to 14 days after the acute stroke but advice from a stroke consultant should be sought about this. […] Antiplatelet drugs are contraindicated unless cause of intracerebral bleed resolves and patients also have concomitant ischaemic heart or stroke disease. […] After the acute phase, all patients with a BP 130mmHg systolic or 80mmHg diastolic should be considered for a long-acting angiotensin-converting enzyme inhibitor (ACEI) and a diuretic (e.g. bendroflumethiazide), if tolerated and not contraindicated. […] Unless contraindicated, treat all patients who have had an ischaemic stroke with a statin regardless of baseline cholesterol concentration. Give atorvastatin oral 80mg daily.

• #42 Transient ischemic attack (TIA) | STROKE MANUAL

  https://www.stroke-manual.com/transient-ischemic-attack-tia/

  start blood pressure treatment ( long-term target BP 130/80 mm Hg, with ACE inhibitors being the preferred due to their protective effects on cerebrovascular health) […] treatdyslipidemiaand manage othervascular risk factors […] even TIA patients can develop post-traumatic stress disorder (PTSD) withdepressionor anxiety […] education and counseling are essential; teach patients adaptive coping skills and carefully explain the realistic risk of stroke associated with TIA

• #43 GGC Medicines – Secondary prevention of Stroke and Transient Ischaemic Attack (TIA)

  https://handbook.ggcmedicines.org.uk/guidelines/cardiovascular-system/secondary-prevention-of-stroke-and-transient-ischaemic-attack-tia/

  If the patient is allergic or intolerant to clopidogrel, then prescribe combination therapy: Aspirin oral 300mg each day for 14 days or until hospital discharge, then reduce to aspirin oral 75 mg each day. […] Patients will usually start oral anticoagulants 10 to 14 days after the acute stroke but advice from a stroke consultant should be sought about this. […] Antiplatelet drugs are contraindicated unless cause of intracerebral bleed resolves and patients also have concomitant ischaemic heart or stroke disease. […] After the acute phase, all patients with a BP 130mmHg systolic or 80mmHg diastolic should be considered for a long-acting angiotensin-converting enzyme inhibitor (ACEI) and a diuretic (e.g. bendroflumethiazide), if tolerated and not contraindicated. […] Unless contraindicated, treat all patients who have had an ischaemic stroke with a statin regardless of baseline cholesterol concentration. Give atorvastatin oral 80mg daily.

• #44 Transient Ischemic Attack: Part II. Risk Factor Modification and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0915/p527.html

  Interventions following a transient ischemic attack are aimed at preventing a future episode or stroke. […] For long-term prevention of future stroke, the American Heart Association/American Stroke Association recommends antiplatelet agents, statins, and carotid artery intervention for advanced stenosis. […] Aspirin, extended-release dipyridamole/aspirin, and clopidogrel are acceptable first-line antiplatelet agents. […] Statins have also been shown to reduce the risk of stroke following transient ischemic attack, with maximal benefit occurring with at least a 50 percent reduction in low-density lipoprotein cholesterol level or a target of less than 70 mg per dL (1.81 mmol per L). […] For those with transient ischemic attack and carotid artery stenosis, carotid endarterectomy is recommended if stenosis is 70 to 99 percent, and perioperative morbidity and mortality are estimated to be less than 6 percent.

• #45 GGC Medicines – Secondary prevention of Stroke and Transient Ischaemic Attack (TIA)

  https://handbook.ggcmedicines.org.uk/guidelines/cardiovascular-system/secondary-prevention-of-stroke-and-transient-ischaemic-attack-tia/

  If initial blood sugar is elevated, investigate for diabetes including checking fasting blood sugar and HbA1c. […] All stroke or TIA patients with symptoms potentially related to their carotid artery circulation territory should have carotid imaging requested immediately and the results discussed with the Stroke Consultant. […] In a patient with moderate to severe (50% stenosis) carotid disease, discuss immediately with the local stroke team to assess need for further imaging, suitability for surgery and the need for any alteration in secondary prevention medication. […] All stroke or TIA patients who do not have already known AF should be investigated for possible AF with a request made for 72 hour ambulatory ECG monitoring.

• #46 Transient Ischemic Attack Treatment & Management: Approach Considerations, Patient Disposition, Management of Hypertension

  https://emedicine.medscape.com/article/1910519-treatment

  Ideally, decisions regarding ED evaluation and inpatient versus rapid outpatient follow-up are made in concert with a neurologist. […] Patients selected for outpatient care should have a clear follow-up plan and stroke prevention initiated as described, including antiplatelet medication and risk-factor modification. […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend encouraging patients to follow a Mediterranean-type diet and to reduce their sodium intake at least 1 g/d sodium (2.5 g/d salt). […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend that patients with stroke or TIA who are capable of physical activity engage in at least moderate-intensity aerobic activity for a minimum of 10 min 4 times a week or vigorous-intensity aerobic activity for a minimum of 20 min twice a week.

• #47 Transient ischemic attack (TIA) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/symptoms-causes/syc-20355679

  If you think you’re having or have had a transient ischemic attack, get medical attention right away. TIAs most often occur hours or days before a stroke. Being evaluated quickly means healthcare professionals can pinpoint potential treatable conditions. Treating those conditions may help you prevent a stroke. […] Knowing your risk factors and living healthfully are the best things you can do to prevent a transient ischemic attack. A healthy lifestyle includes getting regular medical checkups. […] Don’t smoke. Stopping smoking reduces your risk of a TIA or a stroke. […] Limit cholesterol and fat. Cutting back on cholesterol and fat, especially saturated fat and trans fat, in your diet may reduce buildup of plaques in the arteries. […] Exercise regularly. If you have high blood pressure, regular exercise is one of the few ways you can lower your blood pressure without medicines. […] Control diabetes. You can manage diabetes and high blood pressure with diet, exercise, weight control and, when necessary, medicine.

• #48 Transient Ischemic Attack Treatment & Management: Approach Considerations, Patient Disposition, Management of Hypertension

  https://emedicine.medscape.com/article/1910519-treatment

  Ideally, decisions regarding ED evaluation and inpatient versus rapid outpatient follow-up are made in concert with a neurologist. […] Patients selected for outpatient care should have a clear follow-up plan and stroke prevention initiated as described, including antiplatelet medication and risk-factor modification. […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend encouraging patients to follow a Mediterranean-type diet and to reduce their sodium intake at least 1 g/d sodium (2.5 g/d salt). […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend that patients with stroke or TIA who are capable of physical activity engage in at least moderate-intensity aerobic activity for a minimum of 10 min 4 times a week or vigorous-intensity aerobic activity for a minimum of 20 min twice a week.

• #49 Medical Treatment to Prevent Transient Ischemic Attacks and Ischemic Stroke – Clinical Tree

  https://clinicalpub.com/medical-treatment-to-prevent-transient-ischemic-attacks-and-ischemic-stroke/

  The risk for stroke and TIA is affected by various modifiable and nonmodifiable risk factors ( Box 2 ). Treatment recommendations have been established ( Table 1 ). […] Treatment with proven reduction of stroke exists. […] Lifestyle modifications are encouraged for all and include weight reduction for overweight patients, limitation of ethanol intake, increased aerobic physical activity (30-45 minutes daily), reduction of sodium intake (2.34 g), maintenance of adequate dietary potassium (120 mmol/day), smoking cessation, and DASH diet (rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat). […] A meta-analysis of 29 trials including 162,341 patients concluded that stroke risk is effectively reduced by lowering pressure (23%; 95% confidence interval [CI], 5%-37%). Most of the effect was not a direct result of the chosen pharmacologic regimen but rather was secondary to absolute reduction of blood pressure.

• #50 Transient Ischemic Attack Treatment & Management: Approach Considerations, Patient Disposition, Management of Hypertension

  https://emedicine.medscape.com/article/1910519-treatment

  Ideally, decisions regarding ED evaluation and inpatient versus rapid outpatient follow-up are made in concert with a neurologist. […] Patients selected for outpatient care should have a clear follow-up plan and stroke prevention initiated as described, including antiplatelet medication and risk-factor modification. […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend encouraging patients to follow a Mediterranean-type diet and to reduce their sodium intake at least 1 g/d sodium (2.5 g/d salt). […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend that patients with stroke or TIA who are capable of physical activity engage in at least moderate-intensity aerobic activity for a minimum of 10 min 4 times a week or vigorous-intensity aerobic activity for a minimum of 20 min twice a week.

• #51 Medical Treatment to Prevent Transient Ischemic Attacks and Ischemic Stroke – Clinical Tree

  https://clinicalpub.com/medical-treatment-to-prevent-transient-ischemic-attacks-and-ischemic-stroke/

  The risk for stroke and TIA is affected by various modifiable and nonmodifiable risk factors ( Box 2 ). Treatment recommendations have been established ( Table 1 ). […] Treatment with proven reduction of stroke exists. […] Lifestyle modifications are encouraged for all and include weight reduction for overweight patients, limitation of ethanol intake, increased aerobic physical activity (30-45 minutes daily), reduction of sodium intake (2.34 g), maintenance of adequate dietary potassium (120 mmol/day), smoking cessation, and DASH diet (rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat). […] A meta-analysis of 29 trials including 162,341 patients concluded that stroke risk is effectively reduced by lowering pressure (23%; 95% confidence interval [CI], 5%-37%). Most of the effect was not a direct result of the chosen pharmacologic regimen but rather was secondary to absolute reduction of blood pressure.

• #52 Transient ischemic attack (TIA) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/symptoms-causes/syc-20355679

  If you think you’re having or have had a transient ischemic attack, get medical attention right away. TIAs most often occur hours or days before a stroke. Being evaluated quickly means healthcare professionals can pinpoint potential treatable conditions. Treating those conditions may help you prevent a stroke. […] Knowing your risk factors and living healthfully are the best things you can do to prevent a transient ischemic attack. A healthy lifestyle includes getting regular medical checkups. […] Don’t smoke. Stopping smoking reduces your risk of a TIA or a stroke. […] Limit cholesterol and fat. Cutting back on cholesterol and fat, especially saturated fat and trans fat, in your diet may reduce buildup of plaques in the arteries. […] Exercise regularly. If you have high blood pressure, regular exercise is one of the few ways you can lower your blood pressure without medicines. […] Control diabetes. You can manage diabetes and high blood pressure with diet, exercise, weight control and, when necessary, medicine.

• #53 Transient Ischemic Attack (TIA): Mini Stroke Symptoms, Causes

  https://www.medicinenet.com/transient_ischemic_attack_tia_mini-stroke/article.htm

  Two classes of drugs are recommended to be started at the same time, a diuretic and an ACE inhibitor. […] Guidelines recommend that a statin drug be started, even if cholesterol levels are normal. […] Smoking, excessive alcohol, obesity, and lack of physical activity are considered risks for future stroke. […] Counseling, smoking cessation aids like nicotine gum, or medications like varenicline (Chantix) should be considered. […] Intake should be limited to two or fewer drinks a day for men and one or less for women. […] Overweight people should try to lose weight using a combination of diet, exercise, and counseling. […] 30 minutes of moderate exercise daily is recommended for those who are able.

• #54 Transient Ischemic Attack (TIA): Mini Stroke Symptoms, Causes

  https://www.medicinenet.com/transient_ischemic_attack_tia_mini-stroke/article.htm

  Two classes of drugs are recommended to be started at the same time, a diuretic and an ACE inhibitor. […] Guidelines recommend that a statin drug be started, even if cholesterol levels are normal. […] Smoking, excessive alcohol, obesity, and lack of physical activity are considered risks for future stroke. […] Counseling, smoking cessation aids like nicotine gum, or medications like varenicline (Chantix) should be considered. […] Intake should be limited to two or fewer drinks a day for men and one or less for women. […] Overweight people should try to lose weight using a combination of diet, exercise, and counseling. […] 30 minutes of moderate exercise daily is recommended for those who are able.

• #55 Transient Ischemic Attack (Mini-Stroke) Supportive Therapy Guide

  https://www.cognitivefxusa.com/blog/transient-ischemic-attack-supportive-therapy

  Depending on their symptoms, some patients may receive brief physical, occupational, or speech therapy at the hospital or shortly thereafter. However, this therapy tends to be short-term, and some patients may need continued support in treating their stroke symptoms. […] To help treat these symptoms or reduce the risk of future mini-strokes, patients might consider the following therapies or services based on their needs: Physical therapy, Occupational therapy, Speech therapy, Vision therapy, Pharmacologic therapy, Dietitian services, Physical training services. […] In the best-case scenario, some combination of these supportive therapies will help patients who’ve suffered a TIA heal and return to normal activity. However, it’s not unusual for some of the symptoms mentioned above to persist, often accompanied by cognitive and emotional challenges.

• #56 Treatment Options for Transient Ischemic Attack (Mini-Stroke)

  https://www.cognitivefxusa.com/blog/transient-ischemic-attack-treatment-options

  For some patients, the best option to prevent a stroke in the future is a surgical intervention. […] Patients are also advised to make lifestyle changes to reduce the risk of stroke and support cardiovascular health. […] Some of the supportive therapies that can help TIA patients include: Physical Therapy […] Occupational Therapy […] Cognitive Therapy […] Speech and Language Therapy […] Vision Therapy […] Counseling […] If left untreated, these symptoms make it harder for patients to return to their daily activities, including work and family commitments, and lower their quality of life. […] To see if our team at Cognitive FX can help you, schedule a consultation.

• #57 Transient Ischemic Attack (Mini-Stroke) Supportive Therapy Guide

  https://www.cognitivefxusa.com/blog/transient-ischemic-attack-supportive-therapy

  Depending on their symptoms, some patients may receive brief physical, occupational, or speech therapy at the hospital or shortly thereafter. However, this therapy tends to be short-term, and some patients may need continued support in treating their stroke symptoms. […] To help treat these symptoms or reduce the risk of future mini-strokes, patients might consider the following therapies or services based on their needs: Physical therapy, Occupational therapy, Speech therapy, Vision therapy, Pharmacologic therapy, Dietitian services, Physical training services. […] In the best-case scenario, some combination of these supportive therapies will help patients who’ve suffered a TIA heal and return to normal activity. However, it’s not unusual for some of the symptoms mentioned above to persist, often accompanied by cognitive and emotional challenges.

• #58 Transient Ischaemic Attack (TIA)

  https://www.physio.co.uk/what-we-treat/neurological/conditions/transient-ischaemic-attack-tia.php

  At Physio.co.uk our specialised neurological physiotherapists commonly treat people following a TIA. Physiotherapy treatment should commence as soon as possible in order to utilise the brains capability of changing following damage and to enhance recovery. […] Many people that we treat who have been discharged from the NHS with no rehab potential benefit from physiotherapy treatment and go on to make significant long term improvements. This can be months or years after their TIA. Our neurological physiotherapists at Physio.co.uk we initial assess your current level of function and set some short and long term treatment goals suited to your individual needs so that you reach your optimum potential. Physiotherapy will be focused on: […] Our specialised neurological physiotherapists understand the difficulties a person will face following a stroke with everyday tasks. At Physio.co.uk, our neurological physiotherapist will work closely with you and your family/carers to ensure you get the best possible treatment. Physiotherapy treatment will depend on your individual needs but will consist of a graduated rehabilitation program of functional exercises which may include: […] At Physio.co.uk out neurological physiotherapist will guide and support you throughout your treatment that will enable you t reach your maximum potential and become more independent with everyday activities.

• #59 Transient Ischemic Attack (Mini-Stroke) Supportive Therapy Guide

  https://www.cognitivefxusa.com/blog/transient-ischemic-attack-supportive-therapy

  Depending on their symptoms, some patients may receive brief physical, occupational, or speech therapy at the hospital or shortly thereafter. However, this therapy tends to be short-term, and some patients may need continued support in treating their stroke symptoms. […] To help treat these symptoms or reduce the risk of future mini-strokes, patients might consider the following therapies or services based on their needs: Physical therapy, Occupational therapy, Speech therapy, Vision therapy, Pharmacologic therapy, Dietitian services, Physical training services. […] In the best-case scenario, some combination of these supportive therapies will help patients who’ve suffered a TIA heal and return to normal activity. However, it’s not unusual for some of the symptoms mentioned above to persist, often accompanied by cognitive and emotional challenges.

• #60 Transient Ischemic Attack (Mini-Stroke) Supportive Therapy Guide

  https://www.cognitivefxusa.com/blog/transient-ischemic-attack-supportive-therapy

  Depending on their symptoms, some patients may receive brief physical, occupational, or speech therapy at the hospital or shortly thereafter. However, this therapy tends to be short-term, and some patients may need continued support in treating their stroke symptoms. […] To help treat these symptoms or reduce the risk of future mini-strokes, patients might consider the following therapies or services based on their needs: Physical therapy, Occupational therapy, Speech therapy, Vision therapy, Pharmacologic therapy, Dietitian services, Physical training services. […] In the best-case scenario, some combination of these supportive therapies will help patients who’ve suffered a TIA heal and return to normal activity. However, it’s not unusual for some of the symptoms mentioned above to persist, often accompanied by cognitive and emotional challenges.

• #61 Transient Ischemic Attack (Mini-Stroke) Supportive Therapy Guide

  https://www.cognitivefxusa.com/blog/transient-ischemic-attack-supportive-therapy

  Depending on their symptoms, some patients may receive brief physical, occupational, or speech therapy at the hospital or shortly thereafter. However, this therapy tends to be short-term, and some patients may need continued support in treating their stroke symptoms. […] To help treat these symptoms or reduce the risk of future mini-strokes, patients might consider the following therapies or services based on their needs: Physical therapy, Occupational therapy, Speech therapy, Vision therapy, Pharmacologic therapy, Dietitian services, Physical training services. […] In the best-case scenario, some combination of these supportive therapies will help patients who’ve suffered a TIA heal and return to normal activity. However, it’s not unusual for some of the symptoms mentioned above to persist, often accompanied by cognitive and emotional challenges.

• #62 Transient ischemic attack (TIA) | STROKE MANUAL

  https://www.stroke-manual.com/transient-ischemic-attack-tia/

  start blood pressure treatment ( long-term target BP 130/80 mm Hg, with ACE inhibitors being the preferred due to their protective effects on cerebrovascular health) […] treatdyslipidemiaand manage othervascular risk factors […] even TIA patients can develop post-traumatic stress disorder (PTSD) withdepressionor anxiety […] education and counseling are essential; teach patients adaptive coping skills and carefully explain the realistic risk of stroke associated with TIA

• #63

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  If a TIA is rapidly diagnosed and appropriate interventions initiated, the risk of subsequent stroke can be significantly reduced. […] Administer aspirin, statin and antihypertensive treatment immediately after symptoms have resolved unless contraindicated (e.g. history of intracranial haemorrhage, anticoagulant treatment or hypotensive). […] The Early Use of Existing Preventive Strategies for Stroke (EXPRESS) trial of immediate, multiple pharmacotherapy after TIA demonstrated an 80% reduction in early recurrent stroke and improved patient outcomes, compared to less aggressive treatment. […] Following TIA the risk of stroke is dangerously elevated. […] Referral for assessment is usually required in order to eliminate possible TIA mimics (e.g. subdural haematoma or brain tumour), to gain timely access to investigations and to assist in the development of a long-term treatment plan for secondary stroke prevention.

• #64 Management of Acute Stroke and Transient Ischemic Stroke – An Integrated, Systematic Approach from the Emergency Department to the Inpatient Setting to Discharge | Radcliffe Cardiology

  https://www.radcliffecardiology.com/articles/management-acute-stroke-and-transient-ischemic-stroke-integrated-systematic-approach?language_content_entity=en

  In the past two decades, we have seen major advances in the treatment of transient ischemic attack (TIA) and acute ischemic stroke. […] Effective treatment of TIA and stroke requires an integrated, systematic approach that begins in the ED, continues in the inpatient setting, and is maintained after discharge. […] Acute management of TIA and stroke in the ED requires rapid assessment, diagnostic testing, neuroimaging, thrombolysis or thrombectomy if indicated, early antithrombotic intervention, dedicated neurologic monitoring, and supportive care. […] Prompt diagnosis and management of TIA may reduce future stroke rates. […] To improve the speed of clinical assessment, diagnosis, and early management decisions for patients with TIA or stroke, a dedicated stroke team and protocol can be useful.

• #65

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  A transient ischaemic attack (TIA) is a medical emergency due to the high risk that stroke will occur within the next 48 hours. […] Once symptoms are resolved, patients should immediately be given aspirin, a statin and an antihypertensive medicine (if there are no contraindications). […] Aspirin, a statin and an antihypertensive medicine should be given to all patients immediately following a suspected TIA – if they are fully recovered and without contraindications. […] All patients with a suspected TIA should have their risk of stroke assessed using the ABCD2 tool, and then be referred to secondary care for urgent investigation and treatment (according to local protocols). […] As soon as a diagnosis of TIA is confirmed, risk factors should be assessed and a long-term, individualised secondary prevention plan implemented.

• #66 Let’s Talk About Transient Ischemic Attack (TIA) | American Stroke Association

  https://www.stroke.org/en/help-and-support/resource-library/lets-talk-about-stroke/transient-ischemic-attack

  A transient ischemic attack (TIA) is often called a mini-stroke, but it’s really a warning stroke. […] Since TIA symptoms resolve on their own, your health care provider will likely work with you to address the underlying causes to prevent additional TIAs or a stroke. Treatment options will depend upon the cause or causes, your medical history, and the results of any testing. Treatment often includes medication and lifestyle changes and could include surgery. Effective treatment may help reduce your risk for stroke or another TIA.

• #67 Transient Ischemic Attack Treatment & Management: Approach Considerations, Patient Disposition, Management of Hypertension

  https://emedicine.medscape.com/article/1910519-treatment

  Rapid transport to hospital is essential to evaluate the patient who may have fleeting or stuttering symptoms. […] Initiation of stroke prevention therapy must be provided urgently. Medical management is aimed at reducing both short-term and long-term risk of stroke and varies according to the underlying cause of the episode. […] Although controversy exists regarding the need for hospital admission, there is no controversy regarding the need for urgent evaluation, risk stratification, and initiation of stroke prevention therapy. […] The National Stroke Association consensus guidelines for the management of TIAs recommend considering patient hospitalization if it is the first TIA within the previous 24-48 hours. This would facilitate possible early treatment with tissue plasminogen activator (tPA) and other medical management for recurrent symptoms, and it would expedite risk stratification and implementation of secondary prevention.

• #68 Transient Ischemic Attack: Causes, Symptoms, and Emergency Treatment

  https://mhehc.com/blog/transient-ischemic-attack-causes-symptoms-and-emergency-treatment/

  If you suspect someone is having a TIA, quick action is essential. Here’s what to do: […] Immediate medical care can prevent a full stroke from occurring. […] Quick medical evaluation helps diagnose the cause of TIA. […] Early intervention can lead to more effective treatments. […] Doctors may administer blood thinners or antiplatelet drugs to prevent clots. […] Seeking prompt medical help can greatly improve the chances of preventing a future stroke. […] Incorporating these measures can greatly reduce the risk of future TIAs and improve overall health.

• #69 Transient Ischemic Attack (TIA) | American Stroke Association

  https://www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack

  A transient ischemic attack, or TIA, is a temporary blockage of blood flow to the brain. The clot usually dissolves on its own or gets dislodged, and the symptoms usually last less than five minutes. […] Get help immediately if you think you could be having a TIA. Ideally your comprehensive evaluation should be done within 24 hours of when symptoms began. Here is what you can expect: […] Once TIA is diagnosed, a follow-up visit with a neurologist is recommended to assess your risk of future stroke. […] Appropriate medical care may include: […] Checking the blood flow and tissue within the brain tissue may be important to determine the cause of a TIA or any brief symptoms of stroke. […] Assessing medical history and cardiovascular disease risks, along with evaluating blood chemistry, can help determine the appropriate medication to prevent blood clots or a procedure to remove fatty deposits (plaques) from the arteries that supply blood to brain (carotid endarterectomy).

• #70 Transient Ischemic Attack | Stony Brook Neuroscience Institute

  https://neuro.stonybrookmedicine.edu/centers/cvsc/services/TIA

  At our Rapid Access TIA (Transient Ischemic Attack) clinic, were able to identify and treat people whove had a TIA earlier, to minimize the risk of a disabling or possibly fatal stroke. […] Our Rapid Access TIA Clinic helps your referring physician or provider speed up appointment scheduling, testing and coordinating for you with other sub-specialists you might need to see. […] Same-day diagnostic and treatment series provided include: MRI Brain, CT Angiogram Head and Neck or MRA head and neck, Echocardiogram with Bubble Study, Blood work or a prescription to go to the lab of your choice for your blood work, 30-Day Cardiac Monitor (case-by-case basis), Vascular Neurology Consultation *including review of above studies and personalized secondary stroke prevention strategy.

• #71

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  A transient ischaemic attack (TIA) is a medical emergency due to the high risk that stroke will occur within the next 48 hours. […] Once symptoms are resolved, patients should immediately be given aspirin, a statin and an antihypertensive medicine (if there are no contraindications). […] Aspirin, a statin and an antihypertensive medicine should be given to all patients immediately following a suspected TIA – if they are fully recovered and without contraindications. […] All patients with a suspected TIA should have their risk of stroke assessed using the ABCD2 tool, and then be referred to secondary care for urgent investigation and treatment (according to local protocols). […] As soon as a diagnosis of TIA is confirmed, risk factors should be assessed and a long-term, individualised secondary prevention plan implemented.

• #72 GGC Medicines – Secondary prevention of Stroke and Transient Ischaemic Attack (TIA)

  https://handbook.ggcmedicines.org.uk/guidelines/cardiovascular-system/secondary-prevention-of-stroke-and-transient-ischaemic-attack-tia/

  Secondary prevention of stroke should be considered in all patients as soon as possible after their stroke or TIA. […] Initiation of secondary prevention investigations and treatment should be guided by the stroke team, therefore, ensure that all new stroke or TIA patients are referred to the local stroke service via the TrakCare referral form. […] First choice is aspirin oral 300mg daily for 14 days then clopidogrel oral 75mg each day (N.B. clopidogrel is unlicensed in TIA). […] DAPT (aspirin and clopidogrel) can be used in people with non-cardioembolic minor ischaemic stroke (NIHSS score of 3 or less) or high-risk TIA (ABCD score of 4 or more) in the past 24 hours, if diagnosis is confirmed by a stroke specialist and brain imaging has excluded intracerebral haemorrhage (ICH). DAPT is usually used for 21 days, then the patient continues on clopidogrel 75mg daily for long-term treatment.

• #73 Transient Ischemic Attack (TIA) Treatment and Diagnosis | Brown University Health

  https://www.brownhealth.org/centers-services/comprehensive-stroke-center-rhode-island-hospital/tia-eval-treatment

  Patients who arrive in the TIA unit with suspected TIA are immediately evaluated by a team of providers. […] Those experiencing a TIA are treated immediately with medication, and then monitored for 24 hours in the unit. […] Once a Rhode Island Hospital provider diagnoses the cause of the transient ischemic attack (TIA), a treatment plan will be developed to address the issue and to prevent a stroke from occurring. Treatment options vary depending on the underlying cause of the TIA, and your provider may recommend medication, surgery, or a balloon procedure (angioplasty). […] Often, antiplatelet medications, like aspirin, Aggrenox, and Clopidogrel, are prescribed for TIAs because they help reduce the ability of blood platelets to stick together into clots. Blood clots are a common cause of TIAs and strokes.

• #74 Transient Ischemic Attack | Stony Brook Neuroscience Institute

  https://neuro.stonybrookmedicine.edu/centers/cvsc/services/TIA

  At our Rapid Access TIA (Transient Ischemic Attack) clinic, were able to identify and treat people whove had a TIA earlier, to minimize the risk of a disabling or possibly fatal stroke. […] Our Rapid Access TIA Clinic helps your referring physician or provider speed up appointment scheduling, testing and coordinating for you with other sub-specialists you might need to see. […] Same-day diagnostic and treatment series provided include: MRI Brain, CT Angiogram Head and Neck or MRA head and neck, Echocardiogram with Bubble Study, Blood work or a prescription to go to the lab of your choice for your blood work, 30-Day Cardiac Monitor (case-by-case basis), Vascular Neurology Consultation *including review of above studies and personalized secondary stroke prevention strategy.

• #75 Transient ischaemic attack – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000090

  A transient ischaemic attack (TIA) should be suspected in anyone who presents with sudden-onset, focal neurological deficit that resolves spontaneously and cannot be explained by another condition such as hypoglycaemia. […] If you see the patient while they are having ongoing neurological symptoms or soon after, use the National Institutes of Health Stroke Scale (NIHSS) to help identify the need for urgent treatment (thrombolysis). Admit anyone with suspected stroke directly to a hyperacute (or acute, depending on availability) stroke unit within 4 hours of presentation. […] Following your initial assessment, give a loading dose of aspirin to anyone with suspected TIA and refer the patient immediately for specialist assessment to be seen within 24 hours of onset of symptoms. […] The risk of recurrent stroke is high in the first 7 days following a TIA. Start secondary prevention therapy immediately once the diagnosis of TIA is confirmed.

• #76 Transient Ischemic Attack | Stony Brook Neuroscience Institute

  https://neuro.stonybrookmedicine.edu/centers/cvsc/services/TIA

  At our Rapid Access TIA (Transient Ischemic Attack) clinic, were able to identify and treat people whove had a TIA earlier, to minimize the risk of a disabling or possibly fatal stroke. […] Our Rapid Access TIA Clinic helps your referring physician or provider speed up appointment scheduling, testing and coordinating for you with other sub-specialists you might need to see. […] Same-day diagnostic and treatment series provided include: MRI Brain, CT Angiogram Head and Neck or MRA head and neck, Echocardiogram with Bubble Study, Blood work or a prescription to go to the lab of your choice for your blood work, 30-Day Cardiac Monitor (case-by-case basis), Vascular Neurology Consultation *including review of above studies and personalized secondary stroke prevention strategy.

• #77 Transient Ischemic Attack | Conditions & Treatments | UR Medicine

  https://www.urmc.rochester.edu/conditions-and-treatments/transient-ischemic-attack

  Depending on the timing of your event, your healthcare provider may refer you to an Emergency Department or to the Ambulatory UR Medicine Rapid Access TIA clinic and Neurovascular Laboratory. […] Patients referred to the TIA clinic will be evaluated and treated by our expert stroke neurologists. Our experts will also tell you about stroke risk factors and stroke prevention. […] Our comprehensive evaluation includes: Neurological consult, Neurosurgical consult (if needed), Onsite MRI and MRA imaging, Onsite ultrasounds, Immediate test results and treatment options, TIA and stroke education, Follow-up care, as needed. […] Findings from the evaluation will also be communicated to the referring physician.

• #78 Transient Ischemic Attack Treatment & Management: Approach Considerations, Patient Disposition, Management of Hypertension

  https://emedicine.medscape.com/article/1910519-treatment

  Ideally, decisions regarding ED evaluation and inpatient versus rapid outpatient follow-up are made in concert with a neurologist. […] Patients selected for outpatient care should have a clear follow-up plan and stroke prevention initiated as described, including antiplatelet medication and risk-factor modification. […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend encouraging patients to follow a Mediterranean-type diet and to reduce their sodium intake at least 1 g/d sodium (2.5 g/d salt). […] Guidelines from the American Heart Association/American Stroke Association (AHA/ASA) recommend that patients with stroke or TIA who are capable of physical activity engage in at least moderate-intensity aerobic activity for a minimum of 10 min 4 times a week or vigorous-intensity aerobic activity for a minimum of 20 min twice a week.

• #79

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  All patients with a confirmed TIA require primary care follow-up (often in conjunction with secondary care) to establish an individual treatment plan for long-term stroke risk reduction. […] Long-term preventative treatment includes: Antiplatelet treatment, Anticoagulation (for people with atrial fibrillation), Blood pressure lowering treatment, Cholesterol lowering treatment, Nicotine replacement treatment or other smoking cessation aids. […] Following a TIA, and provided the patient does not have atrial fibrillation (AF), commence antiplatelet treatment (if not taking an anticoagulant). […] Anticoagulation treatment should begin for all patients with TIA and AF as soon as brain imaging has excluded haemorrhage or another cause for the symptoms. […] Statin treatment has been shown to marginally reduce the incidence of all stroke and to clearly reduce the incidence of ischaemic stroke in patients with a prior TIA.

• #80 Transient ischaemic attack (TIA) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/transient-ischaemic-attack-tia

  A transient ischaemic attack (TIA) is when blood cant get to all parts of your brain for a short time. […] Your doctor will arrange tests. They will talk with you about how you can lower your risk of having a stroke. […] A person who has had a TIA is at greater risk of having a stroke or heart attack. Early identification of symptoms and a diagnosis from your doctor greatly reduces the chances of a major stroke. […] Your doctor will talk with you about your risk factors and medical problems. They will let you know if you need treatment. They will talk with you about what you can do to lower your risk of stroke. […] After a TIA, your doctor may prescribe: Blood pressure lowering medication, Cholesterol lowering medication, Blood thinning medication. […] Your doctor will discuss your test results with you and make a plan for follow up. It is important to go to any appointments arranged by your doctor.

• #81 Transient ischemic attack (TIA) | STROKE MANUAL

  https://www.stroke-manual.com/transient-ischemic-attack-tia/

  start blood pressure treatment ( long-term target BP 130/80 mm Hg, with ACE inhibitors being the preferred due to their protective effects on cerebrovascular health) […] treatdyslipidemiaand manage othervascular risk factors […] even TIA patients can develop post-traumatic stress disorder (PTSD) withdepressionor anxiety […] education and counseling are essential; teach patients adaptive coping skills and carefully explain the realistic risk of stroke associated with TIA

• #82

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  All patients with a confirmed TIA require primary care follow-up (often in conjunction with secondary care) to establish an individual treatment plan for long-term stroke risk reduction. […] Long-term preventative treatment includes: Antiplatelet treatment, Anticoagulation (for people with atrial fibrillation), Blood pressure lowering treatment, Cholesterol lowering treatment, Nicotine replacement treatment or other smoking cessation aids. […] Following a TIA, and provided the patient does not have atrial fibrillation (AF), commence antiplatelet treatment (if not taking an anticoagulant). […] Anticoagulation treatment should begin for all patients with TIA and AF as soon as brain imaging has excluded haemorrhage or another cause for the symptoms. […] Statin treatment has been shown to marginally reduce the incidence of all stroke and to clearly reduce the incidence of ischaemic stroke in patients with a prior TIA.

• #83

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  If a TIA is rapidly diagnosed and appropriate interventions initiated, the risk of subsequent stroke can be significantly reduced. […] Administer aspirin, statin and antihypertensive treatment immediately after symptoms have resolved unless contraindicated (e.g. history of intracranial haemorrhage, anticoagulant treatment or hypotensive). […] The Early Use of Existing Preventive Strategies for Stroke (EXPRESS) trial of immediate, multiple pharmacotherapy after TIA demonstrated an 80% reduction in early recurrent stroke and improved patient outcomes, compared to less aggressive treatment. […] Following TIA the risk of stroke is dangerously elevated. […] Referral for assessment is usually required in order to eliminate possible TIA mimics (e.g. subdural haematoma or brain tumour), to gain timely access to investigations and to assist in the development of a long-term treatment plan for secondary stroke prevention.

• #84 Transient Ischemic Attack – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459143/

  A transient ischemic attack (TIA) is a medical emergency. Evaluation of TIA should be done urgently with imaging and laboratory studies to decrease the risk of subsequent strokes. Immediate multimodal therapeutic interventions should be initiated. Specific underlying etiology needs to be managed accordingly. This treatment scheme may substantially reduce the risk of recurrent strokes or future TIA by at least 80 percent. […] Immediate multimodality therapeutic interventions should be initiated. These will include aggressive treatment of blood pressure, high-dose statin, antiplatelet therapy, blood sugar control, diet, and exercises. Specific underlying etiology needs to be managed accordingly. This treatment scheme may substantially reduce the risk of recurrent strokes or future TIA by at least 80%.

• #85 Transient Ischemic Attack – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459143/

  The main aim of treatment of TIA is to decrease the risk of subsequent stroke or TIA. Early treatment after a TIA can significantly reduce the risk of early stroke. […] Management of TIAs should focus on treating underlying etiologies. […] Studies in the new millennium already confirmed the importance of expedited evaluation and treatment plus the polytherapy approach. The EXPRESS study in the UK has shown the importance of early intervention versus regular treatment by reducing 80% of the stroke risk. […] More recent studies in China (CHANCE trial) and the multinational POINTE trial also confirmed dual antiplatelet with aspirin and clopidogrel for 3 weeks to 1 month, followed by a single antiplatelet agent, is the best scheme for antiplatelet therapy. […] The other part of the treatment will depend on the underlying etiology of the TIA. Revascularization is recommended for symptomatic cervical internal carotid artery stenosis of 70% or higher. Carotid endarterectomy may have a slight benefit-to-risk ratio compared with endovascular intervention and stenting. […] Oral anticoagulation is indicated for patients with atrial fibrillation or other sources of cardioembolic sources of TIA.

• #86

  https://bpac.org.nz/bpj/2011/october/tia.aspx

  If a TIA is rapidly diagnosed and appropriate interventions initiated, the risk of subsequent stroke can be significantly reduced. […] Administer aspirin, statin and antihypertensive treatment immediately after symptoms have resolved unless contraindicated (e.g. history of intracranial haemorrhage, anticoagulant treatment or hypotensive). […] The Early Use of Existing Preventive Strategies for Stroke (EXPRESS) trial of immediate, multiple pharmacotherapy after TIA demonstrated an 80% reduction in early recurrent stroke and improved patient outcomes, compared to less aggressive treatment. […] Following TIA the risk of stroke is dangerously elevated. […] Referral for assessment is usually required in order to eliminate possible TIA mimics (e.g. subdural haematoma or brain tumour), to gain timely access to investigations and to assist in the development of a long-term treatment plan for secondary stroke prevention.

• #87 TIA Recovery, Tests & Diagnosis | What to Expect After Transient Ischemic Attack

  https://resources.healthgrades.com/right-care/stroke/what-to-expect-after-a-transient-ischemic-attack-tia

  Having a transient ischemic attack (TIA) can be frightening. TIAs have the same symptoms as a stroke, such as weakness on one side of the body, difficulty speaking, vision changes, and confusion. The difference is TIA symptoms resolve within minutes, although they can last as long as 24 hours. Doctors call TIAs mini-strokes or warning strokes, because if you have a TIA, you are at higher risk for stroke later. […] A TIA is a medical emergency, even if the symptoms have gone away. You may believe that if the symptoms have gone, you’re fine, but your risk of having a stroke is highest within the first few hours after a TIA and remains high for the week right after, so it is vital to get help as quickly as you can. […] Once your doctor makes the diagnosis, the next step is to refer you to the appropriate specialist or specialists who can develop your treatment plan based on the TIA cause. For example, if you have untreated diabetes, you may need a referral to an endocrinologist. If your problem is related to high cholesterol levels or heart disease, you may need a cardiologist. In turn, a cardiologist may refer you to a surgeon or an interventional radiologist if you need more invasive treatment, such a surgery.

• #88 Transient Ischemic Attack (TIA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/transient-ischemic-attack-nursing-diagnosis-care-plan/

  Prepare for a carotid endarterectomy if the carotid artery is moderately or severely occluded. […] Carotid angioplasty, also known as stenting, uses a thin wire tube (stent) inserted into the obstructed artery that widens the artery using a balloon-like device. […] Educate the patient on lowering their risk by adhering to preventive measures: Maintain blood pressure below 140/90 mmHg, Maintain total cholesterol below 200 mg/dL, Maintain glucose levels within an optimal range, Adhere to medications prescribed for the above conditions, Eliminate heavy alcohol consumption, Maintain weight within a healthy range, Participate in an exercise regimen, Reduce sodium intake, Do not smoke. […] Patients who experience a TIA should follow up with their primary care physician as soon as possible. If cardiac or neurological causes are identified, referrals to these specialists should occur.

• #89 A Transient Ischemic Attack (TIA) is as Urgent as a Stroke > News > Yale Medicine

  https://www.yalemedicine.org/news/transient-ischemic-attack-urgent-as-stroke

  TIA, or mini-stroke, requires immediate medical attention to help prevent a full-blown stroke later on. […] Once the symptoms of a TIA go away, you might think the urgency has passed. But its still important to call 911 for an ambulance. […] Each year, at least 240,000 Americans have a TIA, according to the AHA/ASA statement, which recommended rapid evaluation of patients who are suspected of having a TIA and hospitalization for certain patients whose assessment reveals a high risk for recurrence of stroke symptoms. […] If your diagnosis is a TIA, a medical evaluation can help determine whether and how best to treat it to prevent a full-blown stroke later on. […] Treatment of the TIA also prevents stroke in some cases. This includes antiplatelet medications, such as aspirin or clopidogrel (Plavix), that prevent blood clots from forming. Anticoagulant medications, such as warfarin (Coumadin) or apixaban (Eliquis) also known as blood thinners, interfere with and slow down the clotting process.

• #90 Transient ischaemic attack (TIA) | Stroke Association

  https://www.stroke.org.uk/stroke/type/tia

  A transient ischaemic attack (TIA or mini-stroke) is the same as a stroke, but the symptoms last a short time. You get stroke symptoms because a clot is blocking the blood supply in your brain. When the clot moves away, the stroke symptoms stop. […] A TIA is a medical emergency, the same as a stroke. If you spot any of the signs of a TIA or stroke, call 999. Do not wait to see if the symptoms pass. If you call 999 with stroke symptoms, you should be taken to hospital. […] You urgently need to find out what caused the TIA and get advice and treatment to help you stay healthy. […] If you do not seek urgent medical help, you may go on to have another TIA or a stroke. So its important to get treatment as soon as possible to reduce your risk. […] The pages below have more information on causes, treatments and reducing the risk of stroke after a TIA.

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