• Aspirin (300 mg daily) should be started immediately, unless it is contraindicated or not tolerated, and continued at this dose until reviewed in secondary care:
• Do not delay initiating aspirin treatment in people with uncontrolled blood pressure.
• Consider gastroprotection (e.g. a proton pump inhibitor) if the person is at high risk of adverse gastrointestinal effects or experiences aspirin-induced dyspepsia.
• Consider clopidogrel (75 mg daily — unlicensed use) only if the person is allergic or cannot tolerate aspirin.
• Both aspirin and clopidogrel are contraindicated in people with active gastrointestinal bleeding or ulceration.
• For further information on antiplatelet therapy (including managing gastrointestinal issues), see the CKS topic on Antiplatelet treatment.
• For people who are already prescribed low-dose aspirin:
• Continue the current dose of aspirin until reviewed in secondary care.
• If non-compliance is suspected, start aspirin 300 mg daily immediately (see above).
• Check for unrecognized risk factors for transient ischaemic attack, such as atrial fibrillation.
• For people who have a transient ischaemic attack while on warfarin:
• Admit immediately for an urgent brain scan to exclude haemorrhagic stroke.
• Other measures for secondary prevention should be introduced as soon as the diagnosis is confirmed.

In depth