Transient ischemic attack medical therapy
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Transient ischemic attack Microchapters |
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Differentiating Transient Ischemic Attack from other Diseases |
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Transient ischemic attack medical therapy On the Web |
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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 c) Long term management and follow up
Early assessment
- 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
NSA guidelines
24-48 hours <1 week'
Pharmacological therapy
=Hypertension
Non cardioembolic TIA
Cardioembolic TIA
Long Term management=
The mainstay of treatment following acute recovery from a TIA should be to diagnose and treat the underlying cause. It is not always immediately possible to tell the difference between a CVA (stroke) and a TIA. Most patients who are diagnosed at a hospital's Accident & Emergency Department as having suffered from a TIA will be discharged home and advised to contact their primary physician to organize further investigations.
The initial treatment is Aspirin, second line is clopidogrel, third line is ticlopidine. If TIA is recurrent after Aspirin treatment, the combination of Aspirin and dipirydamole is needed (Aggrenox).
Some patients may also be given modified release dipyridamole or clopidogrel.
Contraindicated medications
Transient ischemic attack is considered an absolute contraindication to the use of the following medications: