Management Options

Secondary prevention treatments should be started as soon as the diagnosis is confirmed. These treatments are initiated following specialist assessment by the stroke/medical team rather than the ED physician.

Lifestyle modification

• Discussion of individual lifestyle factors, including smoking/alcohol reduction, combined with diet and exercise optimisation.

Medications

• Clopidogrel 300mg loading dose, followed by 75mg daily
• High intensity statin therapy with atorvastatin 20-80 mg daily
• Blood pressure-lowering therapy with a thiazide-like diuretic, long-acting calcium channel blocker or angiotensin-converting enzyme inhibitor

Atrial fibrillation

• Patients in atrial fibrillation should be anticoagulated as soon as intracranial bleeding has been excluded and with an anticoagulant that has rapid onset, provided there are no other contraindications.

Admission or discharge with outpatient care

• The latest RCP Guidelines recommend that all patients with a suspected TIA should be assessed within 24 hours by a specialist neurovascular/stroke physician. You should discuss the implications of this guidance for your local service for ED discharge of patients with TIAs to follow up outpatient care.

Admission or discharge with outpatient care

At discharge from hospital, advise the patient not to drive for 4 weeks due to their early risk of having a stroke, and to return to the accident and emergency department if they develop any new neurological symptoms.