Mini-stroke - Treating a transient ischaemic attack

Mini-stroke - Treating a transient ischaemic attack

After having a transient ischaemic attack (TIA), you will need treatment to help prevent another TIA or full stroke from occurring in the future.

Without treatment, there is a one in 10 chance that you will have a full stroke within four weeks of having a TIA. A stroke is a serious health condition that can cause permanent disability and can, in some cases, be fatal.

Your treatment will depend on your individual circumstances, such as your age and medical history.The healthcare team can discuss treatment options with you, and tell you about possible benefits and risks.

To reduce the risk of further TIAs or stroke, you may be prescribed medication and be advised to make changes to your lifestyle.

Some people may also need surgery as part of their treatment programme.

Medication

Platelets are blood cells that help it to clot (thicken). If a blood vessel is damaged, platelets stick together to form a blood clot to prevent bleeding.

Anti-platelet medicines work by reducing the ability of the platelets to stick together and form clots. If you have had a TIA, it is likely you will need anti-platelet medication.

The most commonly prescribed anti-platelet medicines for preventing a TIA, plus two other types of medication, are described below.

Aspirin and dipyridamole

Aspirin is the most commonly prescribed anti-platelet medicine. It is often taken with another anti-platelet medicine called dipyridamole.

Aspirin and dipyridamole are often prescribed together because they are more effective at preventing TIAs and strokes when used in combination compared to when taken separately.

Following a TIA, you will usually be prescribed aspirin and dipyridamole for two years. After this time, you may be able to stop taking dipyridamole and take a low-dose aspirin instead.

Depending on what your GP thinks is the best treatment for you, you may need to take low-dose aspirin indefinitely. A daily low dose of aspirin is thought to reduce your risk of having a TIA by 25%. It can also reduce your risk of having a heart attack.

Side effects of aspirin may include:

• stomach irritation
• indigestion 
• nausea

Side effects of dipyridamole may include:

• headaches 
• dizziness
• nausea 
• diarrhoea 

Clopidogrel

Clopidogrel  is another anti-platelet medicine. It is usually only prescribed if you have:

• severe side effects from taking aspirin
• had a further TIA, despite taking aspirin
• arterial disease

Side effects of clopidogrel may include:

• diarrhoea 
• abdominal pain
• indigestion
• bruising 
• bleeding

Anti-coagulant medication

Anti-coagulant medicines work by reducing the level of certain chemicals in your blood needed to help the blood to clot.

You will usually only be prescribed an anti-coagulant medicine if the blood clot that caused your TIA originated in your heart. This is often due to a condition called atrial fibrillation, which causes your heart to beat irregularly

Warfarin

Warfarin is the anti-coagulant medicine used to help prevent further TIAs.

It is important that you receive the correct dose of warfarin. It must be enough to ensure your blood is 'thinner' (less able to clot), but it should not be so thin that it causes problems, such as internal bleeding.

Your condition will be carefully monitored while you are taking warfarin. You will need regular blood tests, known as international normalised ratio (INR) tests.

An INR test measures how long it takes your blood to clot. Your warfarin dosage may have to be adjusted after an INR test to ensure you are getting the right amount.

Bleeding is the most serious side effect of warfarin. Seek immediate medical attention if you notice any of the following symptoms while taking warfarin:

• passing blood in your urine or stools (faeces)
• passing black faeces
• severe bruising
• prolonged nosebleeds (lasting more than 10 minutes)
• blood in your vomit
• coughing up blood
• unusual headaches
• in women, heavy periods or increased bleeding during your period, or any other bleeding from your vagina

If you are unable to tolerate warfarin, you may be prescribed an oral anti-coagulant medicine, such as dabigatran.

Blood pressure medication

If you have high blood pressure (hypertension), you may have to take medication to control it. This is because high blood pressure significantly increases your risk of having a TIA or stroke.

There are lots of different types of medicine that can help control your blood pressure. Your GP will advise you about which one is the most suitable for you. To be effective, some people have to take a combination of two or three different blood pressure medicines.

Cholesterol medication

High cholesterol is another factor that may increase your risk of having a TIA. You can lower your cholesterol by making certain lifestyle changes, such as eating a healthy, balanced diet.

If your cholesterol level needs to be lowered with medication, you will usually be prescribed a type of medicine known as a statin. Statins help reduce the production of cholesterol in your liver.

Surgery

In some cases, you may need surgery after having a TIA or stroke. A procedure known as a carotid endarterectomy is commonly used.

Carotid endarterectomy
A carotid endarterectomy is a surgical procedure that involves removing part of the lining of the damaged carotid artery, plus any blockage that has built up in the artery.

The carotid arteries deliver blood to your brain. When fatty deposits build up inside the carotid arteries, they become hard and narrow, making it more difficult for blood to flow through them. This is known as atherosclerosis.

If you have atherosclerosis, you may need a carotid endarterectomy to help reduce your risk of having a further TIA or stroke.

However, carotid endarterectomies are not suitable for everyone with atherosclerosis. For example, if your arteries are almost completely blocked, the procedure is unlikely to work.

If your carotid arteries are only partially blocked, you may also be unsuitable for this type of surgery because your risk of having a stroke during the procedure may outweigh the potential benefits of surgery.

A carotid endarterectomy is most suitable for people who have a moderate to severe blockage in their arteries. In such cases, the procedure can reduce the risk of further TIAs and strokes by more than a half.