GGC Medicines


Adult Therapeutics Handbook

Management of Acute Stroke 3

Management of Acute Stroke 3

Transient Ischaemic Attacks (TIAs)

General applicability

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:

  1. Fully conscious
  2. Adequate communication
  3. Safe swallow
  4. Safe mobility (consider home environment)
  5. Adequate social support
  6. Clinic appointment requested and patient and family aware this has been done
  7. Not on anticoagulants
  8. No headache or confusion
  9. No fluctuating symptoms
  10. Must be single episode. Patients with recurrent TIAs should always be admitted
  11. Blood pressure >100/60mmHg and <200/130mmHg
  12. Not in atrial fibrillation
  13. 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
    • ECG
    • 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.