Transient ischemic attack medical therapy: Difference between revisions
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===Guidelines for the hospitalization of patients with TIA=== | ===Guidelines for the hospitalization of patients with TIA=== | ||
====AHA guidelines==== | ====AHA guidelines==== | ||
*ABCD2 score of 3 | |||
*ABCD2 score of 0-2 and uncertainity of completion of work up in 2 days in outpatient | |||
*ABCD2 score of 0-2 and other evidence suggesting patient's transient ischemic attack may be caused by focal ischemia | |||
====NSA guidelines==== | ====NSA guidelines==== | ||
'''24-48 hours'''<br> | '''24-48 hours'''<br> | ||
Revision as of 01:05, 12 December 2016
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Transient ischemic attack Microchapters |
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Differentiating Transient Ischemic Attack from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Transient ischemic attack medical therapy On the Web |
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American Roentgen Ray Society Images of Transient ischemic attack medical therapy |
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Risk calculators and risk factors for Transient ischemic attack medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Medical Therapy
The approach to medical management of patients with transient ischemic attack may involve the following:
a) Early assessment and emergency management
b) Long term management and follow up
Early assessment and emergency management
- Rapid transport to the hospital
- History and examination
- IV access
- Fingerstick glucose to rule out hypoglycemia
- EKG testing to rule out ongoing ischemia
- Neuroimaging to rule out infarction
Risk assessment and management plan
After initial evaluation of patient, the decision to further manage the patient in the emergency department observation unit, hospital admission or outpatient follow up depends on no of factors which may include
- ABCD2 scoring(AHA guidelines)
- Assessment by emergency physician
- Opinion of neurologist
- Risk of future stroke or TIA
- Patient preference
- Local resources
Guidelines for the hospitalization of patients with TIA
AHA guidelines
- ABCD2 score of 3
- ABCD2 score of 0-2 and uncertainity of completion of work up in 2 days in outpatient
- ABCD2 score of 0-2 and other evidence suggesting patient's transient ischemic attack may be caused by focal ischemia
NSA guidelines
24-48 hours
- Hospitalization recommended for early t-PA availability in case of recuurent attack or infarction
- Early risk assessment and management plan
<1 week
Hospitalization in less than a week of TIA may be recommended in following situations:
- Symptoms >1 hour
- Known hypercoaguable disorder
- Symptomatic internal carotid artery stenosis>50
- Two or more TIAs per week (crescendo TIA)
- Cardiac source of embolism (atrial fibrillation)
- California and ABCD2 suggesting admission
Pharmacological therapy
Hypertension
- Blood pressure control may be considered in patients with evidence of end organ damage or levels above 220/120mmHg
- Blood pressure autoregulation without medication may be considered in patients with increased levels in patients with TIA to enhance cerebral perfusion
Non cardioembolic TIA
- Antiplatelet therapy is recommended as first line.
- Aspirin 50-325mg/day, combination of aspirin and extended release dipyridamole and clopidogrel may be considered first line treatment.
- Aspirin and clopidogrel may be started within 24 hours of minor stroke or TIA and may be continued for 21 days.
Cardioembolic TIA
- Anticoagulation may be recommended in patients with known cardiac source of emboli such as atrial fibrillation and acute MI with ventricular thrombus
- Anticoagulation therapy with warfarin may be recommended with target INR 2-3
- Aspirin 325mg may be recommended in patients unable to take anticoagulants