Treatment

Once your doctor has determined the cause of your transient ischemic attack, the goal of treatment is to correct the abnormality and prevent a stroke. Depending on the cause of your TIA, your doctor may prescribe medication to reduce the tendency for blood to clot or may recommend surgery or a balloon procedure (angioplasty).

Medications

Doctors use several medications to decrease the likelihood of a stroke after a transient ischemic attack. The medication selected depends on the location, cause, severity and type of TIA. Your doctor may prescribe:

  • Anti-platelet drugs. These medications make your platelets, one of the circulating blood cell types, less likely to stick together. When blood vessels are injured, sticky platelets begin to form clots, a process completed by clotting proteins in blood plasma.

    The most frequently used anti-platelet medication is aspirin. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix).

    Your doctor may consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. The way dipyridamole works is slightly different from aspirin.

  • Anticoagulants. These drugs include heparin and warfarin (Coumadin, Jantoven). They affect clotting-system proteins instead of platelet function. Heparin is used for a short time and warfarin over a longer term.

    These drugs require careful monitoring. If atrial fibrillation is present, your doctor may prescribe another type of anticoagulant, dabigatran (Pradaxa).

  • Thrombolytic agents. In certain cases, thrombolytic therapy is used to treat an ongoing stroke by dissolving blood clots that are blocking blood flow to the brain. In these situations, the neurologic symptoms and findings will have lasted more than a few minutes and are not improving. The thrombolytic agent alteplase (Activase), also known as a recombinant tissue plasminogen activator, was first approved by the FDA in 1996 to treat strokes within hours of onset.

Surgery

If you have a moderately or severely narrowed neck (carotid) artery, your doctor may suggest carotid endarterectomy (end-ahr-tur-EK-tuh-me). This preventive surgery clears carotid arteries of fatty deposits (atherosclerotic plaques) before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed, and the artery is closed.

Angioplasty

In selected cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloon-like device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open.

April 08, 2017
References
  1. Daroff RB, et al. Ischemic cerebrovascular disease. In: Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Jan. 10, 2017.
  2. Transient ischemic attack information page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Transient-Ischemic-Attack-Information-Page. Accessed Jan. 10, 2017.
  3. Furie KL, et al. Initial evaluation and management of transient ischemic attack and minor stroke. http://www.uptodate.com/home. Accessed Jan. 10, 2017.
  4. TIA (Transient ischemic attack). American Stroke Association. http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/TIA-Transient-Ischemic-Attack_UCM_310942_Article.jsp#.WHfNHVUrJ0w. Accessed Jan. 10, 2017.
  5. Furie KL, et al. Etiology and clinical manifestations of transient ischemic attack. http://www.uptodate.com/home. Accessed Jan. 10, 2017.
  6. Stroke risk factors. American Stroke Association. http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/Understanding-Risk_UCM_308539_SubHomePage.jsp. Accessed Jan. 10, 2017.
  7. Furie KL, et al. Overview of secondary prevention of ischemic stroke. http://www.uptodate.com/home. Accessed Jan. 10, 2017.
  8. Shaughnessy AF. Third-generation oral contraceptives associated with greater risk of PE, Stroke, and MI. American Family Physician. 2016;94:663.
  9. Marx JA, et al., eds. Stroke. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 10, 2017.
  10. Stroke: Hope through research. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Stroke-Hope-Through-Research. National Institute of Neurological Disorders and Stroke. Accessed Jan. 10, 2017.
  11. Demaerschalk BM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:581.
  12. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Oct. 31, 2016.
  13. Swanson JW (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 13, 2017.