TIA Management

Low-risk TIA

  • ABCD scores 0-3
  • out patient work-up in the next 1-2 days
  • alternative is to admit
  • begin ASA 81mg or plavix 75 or ASA 25/ER dipyridamole 200mg BID
  • perform carotid imaging: US, CTA, MRA
  • consider TTE (if bilateral infarcts on CT, high suspicion of cardioembolic source and TTE normal – obtain TEE)
  • consider 30d ambulatory cardiac monitor to document cryptogenic Afib
  • smoking cessation
  • Statins:
    • start high-dose statin (atorvastatin 40-80; rosuvastatin 20-40)
    • consider mod intensity statin if >75 y/o (atorvastatin 10-20, rosuvastatin 5-10, simvastatin 20-40, pravastatin 40-80)
  • consider anticoagulation if ECG (+) Afib, calculate CHADS or CHADSVASC and HAS-BLED scores
  • ? Referral to vascular neurologist or cardiologist

 

High-Risk TIA:

  • admit
  • permissive HTN
  • gradually lower BP limits over 24-48h

 

 

Reference:

Gross, H. and Grose, N. (2017). Emergency Neurological Life Support: Acute Ischemic Stroke. Neurocritical Care, 27(S1), pp.102-115.

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