Transient Ischaemic Attack

Key points

• TIA is now defined tissue-based, not time-based: transient neurological dysfunction from focal ischaemia WITHOUT acute infarction on imaging — the old "resolves within 24 hours" definition is superseded.
• Give aspirin 300 mg immediately unless: a bleeding disorder or on an anticoagulant (admit for urgent imaging to exclude haemorrhage) · already on low-dose aspirin (continue the current dose) · aspirin contraindicated (discuss urgently with the specialist team).
• Suspected TIA within the last 7 days → urgent assessment by a stroke specialist WITHIN 24 HOURS · more than a week ago → specialist assessment as soon as possible within 7 days · advise not to drive until seen.
• Do NOT use ABCD2 to decide urgency — NICE NG128 removed risk-scoring in favour of urgent specialist assessment for everyone with a suspected TIA.
• Crescendo TIA (more than one in a week) or suspected cardioembolic source or severe carotid stenosis → discuss the need for admission or urgent observation with a stroke specialist.
• Long-term antithrombotic: clopidogrel is first-line · aspirin plus dipyridamole if clopidogrel is not tolerated · after a HIGH-RISK TIA, short-term dual antiplatelet therapy (aspirin plus clopidogrel for about 21 days, then clopidogrel alone) is now standard practice, based on CHANCE and POINT.
• Also: high-intensity statin · carotid imaging, with endarterectomy considered for symptomatic severe stenosis in patients who are not severely disabled · anticoagulate if AF is found, once haemorrhage is excluded — after a TIA this can start without waiting 2 weeks.

Decision points in this pathway

• Bleeding disorder, or already taking an anticoagulant?
• Crescendo TIA (more than one in a week), suspected cardioembolic source, or severe carotid stenosis?
• TIA within the last 7 days?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.