How Do You Treat a TIA and Cut Stroke Risks Afterward?

2 answers | Last updated: Jul 26, 2014
A fellow caregiver asked...

What's the recommended treatment following a TIA, and does having a TIA increase the risk of having a bigger stroke?

Expert Answers

Jeremy Payne, M.D., is the medical director of Banner Good Samaritan Stroke Center in Phoenix, Arizona.

There's no treatment needed for the blood clot itself, since a TIA, or transient ischemic attack, is a temporary condition that didn't cause lasting damage. (Also sometimes called a ministroke, TIA is the term for a blood clot that went to the brain but dissipated without damaging the brain.)

But we still have to figure out what's going on that caused the TIA in the first place. The doctor will probably order a number of scans to check the health of the heart and look for plaque in the arteries. It's important to pay particular attention to the carotid artery, since a weakened carotid artery can cause a major stroke.

In many cases, doctors never pinpoint the exact cause of a TIA, just as they often don't find the cause of a stroke. However, anyone who's had a TIA is automatically in a higher-risk category, and the doctor should evaluate all aspects of the health of the patient's heart and arteries. Since doctors often don't find one cause of a TIA, we take the approach of looking at all the risk factors and shaving off some of the risk in all the categories we can. Risk factors we look at include age, family history, and smoking; then we test blood pressure, cholesterol, and other indicators.

If you're a smoker, you'll be advised to quit. Those with elevated blood pressure will be prescribed medication to lower it, as hypertension increases the risk of stroke by four or five times. However, many doctors prescribe blood pressure medication even for those in the normal range after TIAs; experts agree that in the higher-risk category, lower blood pressure is always better. The same with statins (drugs used to lower cholesterol); many doctors now recommend a statin as a preventive measure for anyone who's had a TIA.

The reason for this conservatism is that once you've had a TIA, you're considered to be in a higher-risk category, so the approach to treatment changes. There's lots of evidence that the more we lower peoples' blood pressure, the better, and that being on a statin is better for anyone who falls in the high-risk category.

As far as risk for future stroke, the standard statistic is that anyone who's had a TIA has a 15 to 20 percent increase in their risk of a future stroke. But it's important to realize that most of the elevated risk occurs very soon after the TIA. For example, while it's true that the risk of having a major stroke is elevated by 15 to 20 percent, statistics show that most of that risk falls within the first week.

To put it even more clearly, 1 in 20 will have a stroke within a week after a TIA, and half of those will have it within the first 24 hours. Once that window of danger has passed, the risk keeps dropping over time.

And the more you control the factors that contribute to stroke risk, the more you lower the risk.

Community Answers

Rey answered...

I get sick and tired of all the reasons the patient wasn't taken care of immediatetly...we are not a part of the medical staff that are suppose to be ther to know the answers we are the patients when these tramatic events occur...