Mini-stroke - Treating a transient ischaemic attack

Although the symptoms of a transient ischaemic attack (TIA) resolve in a few minutes or hours without any specific treatment, you will need treatment to help prevent another TIA or a full stroke occurring in the future.

A TIA is a warning sign that you are at a significantly increased risk of having a full stroke in the near future, with the highest risk in the days and weeks following the attack.

A stroke is a serious health condition that can cause permanent disability and can be fatal in some cases, but appropriate treatment following a TIA can help to reduce your risk of having one.

Your treatment will depend on your individual circumstances, such as your age and medical history. The healthcare team can discuss treatment options with you, and tell you about possible benefits and risks.

It’s likely that you will be advised about lifestyle changes you can make to reduce your stroke risk, in addition to being offered medication to treat the underlying cause of your TIA.

You may also need surgery as part of your treatment.

Lifestyle changes

There are a number of lifestyle changes you can make that may help reduce your chances of having a stroke after a TIA.

These include:

eating a healthy diet – a low-fat, reduced salt, high-fibre diet is usually recommended, including plenty of fresh fruit and vegetables
exercising regularly – for most people, at least 150 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week is recommended
stopping smoking – if you smoke, stopping may significantly reduce your risk of having a stroke in the future
cutting down on alcohol – you should aim not to exceed the recommended alcohol limits of three to four units a day for men and two to three units a day for women

Medication

In addition to lifestyle changes, most people who have had a TIA will need to take one or more daily medications indefinitely to help reduce their chances of having a stroke or another TIA.

Some of the main medications used are outlined below.

Antiplatelets

Platelets are blood cells that help blood to clot (thicken). If a blood vessel is damaged, platelets stick together to form a blood clot to prevent bleeding.

Antiplatelet medicines work by reducing the ability of the platelets to stick together and form clots. If you have had a TIA, it is likely that you will be offered antiplatelet medication.

Two common antiplatelets offered to people who have had a TIA are aspirin and clopidogrel. Aspirin may also sometimes be taken with another antiplatelet medicine called dipyridamole because this can be more effective than taking these medications separately.

The main side effects of antiplatelet medications include indigestion and an increased risk of bleeding – for example, you may bleed for longer if you cut yourself, and you may bruise easily.

Read more about aspirin and clopidogrel.

Anticoagulants

Anticoagulant medicines can help to prevent blood clots by changing the chemical composition of the blood in a way that prevents clots.

They are usually offered to people who have had a TIA if the blood clot that caused your TIA originated in your heart. This is often due to a condition called atrial fibrillation, which causes your heart to beat irregularly.

Warfarin, rivaroxaban, dabigatran and apixaban are examples of anticoagulants offered to some people who have had a TIA.

A side effect of all anticoagulants is the risk of bleeding caused by the reduction in the blood's ability to clot. You may need regular blood tests while taking warfarin, so doctors can ensure your dose is not too high or too low.

Antihypertensives (blood pressure medication)

If you have high blood pressure (hypertension), you will be offered a type of medication called an antihypertensive to control it. This is because high blood pressure significantly increases your risk of having a TIA or stroke.

There are lots of different types of medicine that can help control your blood pressure, including:

thiazide diuretics
angiotensin-converting enzyme (ACE) inhibitors
calcium channel blockers
beta-blockers

Your doctor will advise you about which antihypertensive is the most suitable for you. Some people may be offered a combination of two or three different medications.

Read more about treating high blood pressure.

Statins

If you have high cholesterol, you will be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme in the liver that produces cholesterol.

Statins may also help to reduce your risk of a stroke whatever your cholesterol level is, so you may be offered a statin even if your cholesterol level is not particularly high.

Examples of statins often offered to people who have had a TIA include atorvastatin, simvastatin and rosuvastatin.

Surgery

In some cases, a surgical procedure called a carotid endarterectomy may be recommended after having a TIA.

Carotid endarterectomy

A carotid endarterectomy is an operation that involves removing part of the lining of the carotid artery, plus any blockage that has built up in the artery.

The carotid arteries deliver blood to your brain. When fatty deposits build up inside the carotid arteries, they become hard and narrow, making it more difficult for blood to flow through them.

This is known as atherosclerosis and it can lead to TIAs and strokes if the blood supply to the brain becomes disrupted.

By unblocking the carotid arteries in people whose arteries are moderately or severely narrowed, a carotid endarterectomy can significantly reduce the risk of having a stroke or another TIA.

Read more about carotid endarterectomies.