Treating a transient ischaemic attack
If you have had a transient ischaemic attack (TIA), you will need to have treatment to help prevent you from having another TIA, or a full stroke.
The treatment that you need will depend on your individual circumstances, such as your age and medical history. Your healthcare team can discuss the treatment options with you, and tell you about the possible benefits and risks.
To reduce the risk of further TIAs or stroke, you may be given medication or asked to make changes to your lifestyle. These are outlined in TIA - prevention. Some people may also need surgery as part of their TIA treatment.
Medication
Anti-platelet medication
Platelets are the cells in your blood, which help it to clot. When a blood vessel is damaged, platelets stick together to form a blood clot in order 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 that you will need to take anti-platelet medication.
The most commonly prescribed anti-platelet medicines for preventing a TIA are described below.
Aspirin and dipyridamole
Aspirin is the most commonly prescribed anti-platelet. It is often taken along with another anti-platelet medicine called dipyridamole. Aspirin and dipyridamole are often prescribed together because they are more effective at preventing TIA and stroke when they are 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 of aspirin instead. You may have to take low-dose aspirin indefinitely, depending on what your GP thinks is the best treatment for you.
Taking a daily, low dose of aspirin is thought to reduce your risk of a TIA by 25%. It can also reduce your risk of a heart attack.
Side effects of aspirin may include:
- irritation of your stomach
- indigestion
- nausea
Side effects of dipyridamole may include:
- headaches
- dizziness
- nausea
- diarrhoea
Clopidogrel
Clopidogrel is another anti-platelet medicine that is normally only prescribed if:
- you have severe side effects from taking aspirin
- you have had a further TIA, despite taking aspirin
- you have 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 that are needed to help the blood to clot.
You are normally only prescribed an anti-coagulant medicine if the blood clot that caused your TIA originated from your heart. This is often due to a condition that is known as atrial fibrillation (see TIA - causes).
Warfarin
Warfarin is the anti-coagulant medicine that is used to help prevent further TIAs.
The dosage of warfarin that you receive must be enough to ensure that the blood is thinner (less able to clot), but not so thin that it causes problems such as internal bleeding.
Because having the correct dosage of warfarin is so important, your condition will be carefully monitored while you are taking the medication. You will need to have 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. If you notice any of the following symptoms when taking warfarin, seek medical attention immediately:
- passing blood in your urine or faeces
- passing black faeces
- severe bruising
- prolonged nosebleeds (lasting longer than 10 minutes)
- blood in your vomit
- coughing up blood
- unusual headaches
- in women, heavy or increased bleeding during your period, or any other bleeding from your vagina.
High 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 greatly increases your risk of having a TIA or stroke (see TIA - causes).
There are lots of different types of medicine which can help to manage your blood pressure. Your GP will advise you about which one is most suitable for you. In order 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 which may increase your risk of having a TIA. You can help to lower your cholesterol by making a number of lifestyle changes, such as eating a healthy, balanced diet. See TIA - prevention for more information about making lifestyle changes.
If your cholesterol needs to be lowered with medication, you will normally be prescribed a type of medicine known as a statin. Statins help to reduce the production of cholesterol in the liver.
Surgery
Carotid endarterectomy
A carotid endarterectomy is an operation 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 (see TIA - causes).
If you have atherosclerosis, you may need to have a carotid endarterectomy in order to help reduce your risk of having a further TIA or stroke.
A carotid endarterectomy is not suitable for everyone with atherosclerosis. For example, if your arteries are almost completely blocked, a carotid endarterectomy is unlikely to work. If you only have a partial blockage in your carotid arteries, 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 endarterectomy can cut the risk of further strokes occurring by more than a half.
- Anticoagulant
- Anticoagulant is a substance that stops blood from clotting (prevents coagulation). For example warfarin.
- Arteries
- Arteries are blood vessels that carry blood from the heart to the rest of the body.
- Blood
- Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
- Blood vessels
- Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
- Platelets
- Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.
