Management of Acute Stroke 3
Transient Ischaemic Attacks (TIAs)
N.B. TIAs by definition have full resolution of all symptoms within 24 hours, but typically within minutes. Patients with residual symptoms have had a stroke and should be managed according to Acute Stroke 1 guideline: Presentation with focal neurological symptoms, <24 hours and Acute Stroke 2 guideline: The First 24 hours. If in any doubt, admit and follow Acute Stroke 2 guideline.
Suitability for discharge
Patients with TIA can be allowed home only in the following circumstances:
- Fully conscious
- Adequate communication
- Safe swallow
- Safe mobility (consider home environment)
- Adequate social support
- Clinic appointment requested and patient and family aware this has been done
- Not on anticoagulants
- No headache or confusion
- No fluctuating symptoms
- Must be single episode. Patients with recurrent TIAs should always be admitted
- Blood pressure >100/60mmHg and <200/130mmHg
- Not in atrial fibrillation
- Low risk ABCD2 (score ≤3)
If in any doubt, admit and follow Acute Stroke 2 Guideline: The First 24 hours.
Prior to discharge
If the above criteria 1–13 are all satisfactory, then discharge can go ahead but only after the following:
- Check, review and document in the notes:
- Blood glucose
- Blood pressure (admit if <100/60mmHg or >200/130mmHg).
- FBC, U&Es, LFTs and lipids.
- Prescribe aspirin oral 300mg loading dose then clopidogrel oral 75mg daily in accordance with NHSGGC Stroke Antiplatelet Guidelines (see StaffNet, Clinical Guidelines Electronic Resource Directory and search under 'Cardiovascular system').
- Most TIA symptoms last a few minutes only. If symptoms persist for several hours, discuss with a senior whether to image prior to discharge.
- Advise patient not to drive (there is a 1 month ban after a TIA but DVLA do not need to be informed). Document in the notes the advice given.
- Advise patient and carers to return to A&E or call ambulance immediately if any further symptoms.
- Arrange outpatient TIA clinic review by contacting local TIA clinic – information available in A&E Departments. Complete the TIA referral form then phone (and fax) details to the Stroke / TIA secretary for your hospital.