TIA and acute stroke

Question 1

You are a GP and suspect someone has had a TIA in the last week, what is your next course of action?

Answer 1

Aspirin 300mg STAT
unless:
- bleeding disorder or are taking an anticoagulant as haemorrhage requires exclusion — arrange immediate admission for urgent assessment and imaging.
- already on low-dose aspirin regularly — continue the current dose of aspirin until reviewed by a specialist.

Arrange urgent assessment (within 24 hours) by a specialist stroke physician

If crescendo TIA, discuss need for observation/admission urgently with stroke specialist

Question 2

You are a GP and suspect someone has had a TIA more than a week ago, what is your next course of action?

Answer 2

Refer for specialist assessment as soon as possible within 7 days.
Assess for atrial fibrillation and other arrhythmias i.e CHADSVASC2 score

Question 3

You are a GP and suspect someone has an ongoing stroke, what is your next course of action?

Answer 3

Arrange immediate emergency admission to an acute stroke facility for anyone with:

• Persisting neurological symptoms suspected of having acute stroke or emergent TIA.
• Resolved neurological symptoms who has a bleeding disorder or is taking an anticoagulant — haemorrhage must be excluded

Question 4

What are some examples of secondary prevention (drugs) for patients with stroke/TIA in GP land?

Answer 4

High dose statin i.e atorvastatin 20 - 80mg daily
Clopidogrel 75mg daily OD (alt: aspirin + dipyridamole)
ACE-i i.e Ramipril
Anticoagulant therapy i.e warfarin/NOAC –> for patients with AF/atrial flutter

Optimise other co-morbidities i.e diabetes

Question 5

What are some examples of secondary prevention (lifestyle advice) for patients with stroke/TIA in GP land?

Answer 5

Stop smoking
Exercise regularly
Eat healthily - at least five portions of fruit and vegetables (from a variety of sources) per day and two portions of oily fish per week