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Stroke and transient ischaemic attack - Management
What information and advice should I give someone presenting after a transient ischaemic attack?

  • Provide information about the mechanisms and causes of transient ischaemic attacks (TIAs).
  • Advise on the need for people with a TIA to have immediate antithrombotic treatment to reduce the risk of having a stroke within the next few days or weeks. For most people, the appropriate treatment is aspirin.
  • Explain to people that they need specialist assessment and treatment and that they need to be seen urgently, within 24 hours, if the imminent risk for a stroke is high:
    • The assessment is to clarify the diagnosis (and revise it if necessary), determine the cause of the TIA, and decide what further investigations and treatments are needed.
    • Everyone will need blood tests and electrocardiography (ECG). Many people will need a brain scan and/or a scan of their carotid arteries. Some people will need other tests, for example chest radiography, echocardiography, or ambulatory ECG monitoring.
    • People with atrial fibrillation or artificial heart valves will usually need anticoagulation (if they not are already on it).
  • Advise that, after the specialist assessment and treatment, they can reduce their risk of future stroke and other cardiovascular events by adopting a healthier lifestyle and taking drugs to reduce certain risk factors. For details, see Prevention.
  • Advise on driving restrictions:
    • The person should not drive until they have been assessed by a specialist (when definitive guidance will be given).
    • Driving is not permitted until at least 1 month after a TIA.
    • Return to driving should be discussed with the GP or stroke team.
    • People who have had a TIA and hold a heavy goods vehicle licence must contact the Driver and Vehicle Licensing Agency.
    • For more details, see Driving after a stroke or TIA.
  • Additional information and advice is available from the Stroke Association:
    • Stroke Information Service, The Stroke Association, 240 City Road, London EC1V 2PR
    • Online: www.stroke.org.uk
    • Helpline: 0845 3033 100 (calls charged at local rate, open Monday to Friday, 9 a.m. to 5 p.m.)

In depth

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