Transient Ischemic Attack (TIA): Treatment Overview

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Treatment Overview

If you have had a transient ischemic attack (TIA), you will probably need to take a medicine to help prevent blood clots. If the carotid arteries in your neck are significantly blocked, you may also need to have surgery to reopen the narrowed arteries. In addition, if you have high blood pressure, diabetes, or high cholesterol, you will also need treatment for those diseases.

Initial treatment

If you have symptoms of a transient ischemic attack (TIA), seek medical help immediately. If your symptoms have gone away, contact your doctor as soon as possible. A TIA is a sign that a stroke may soon follow, and prompt medical treatment may prevent a stroke. About 14% of people who survive a first TIA or stroke will have another TIA or a stroke within a year.¹

You will need to take medicine that will reduce the risk of future blood clots. These medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.

If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). Endarterectomy surgery also may be appropriate for some people who have not had a TIA but who have significant narrowing in an artery.

Another option to reopen narrowed carotid arteries is angioplasty with stenting. This procedure is much like the one used to open up clogged heart arteries. A doctor threads a thin tube called a catheter through an artery and up to the carotid arteries in your neck, and then he or she inflates a tiny balloon to enlarge the narrowed artery. The doctor places a wire mesh device called a stent in the artery to keep it open. Carotid artery stenting is not as common as endarterectomy.

Should I have carotid endarterectomy surgery for TIA?

Ongoing treatment

Ongoing treatment will focus on preventing another transient ischemic attack (TIA) or stroke and reducing additional risk factors for stroke. This may include:

• Reducing high blood pressure, the most common risk factor for stroke, by making changes to your diet and taking blood pressure–lowering medicines.
• Taking aspirin or another antiplatelet medicine to prevent strokes. It has been shown that people who have had a stroke, a TIA, or an endarterectomy may benefit from taking aspirin or another antiplatelet medicine, such as aspirin with extended-release dipyridamole, daily to prevent another stroke.
• Taking anticoagulant medicines, which are commonly called blood thinners, if you have atrial fibrillation. People with atrial fibrillation who have had a TIA usually need to take anticoagulants, such as warfarin (Coumadin, for example) to reduce their risk of stroke. Studies show that anticoagulants are better than antiplatelet medicines (like aspirin) at preventing strokes for this group of people.⁴ Some people cannot take anticoagulants, however. In this case, you will probably be given another medicine to reduce your chance of having a stroke.
• Taking medicines such as statins to lower high cholesterol. Many studies show that statins significantly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.⁵
• Controlling diabetes. Your doctor will advise that you try to keep your blood sugar levels at normal or near-normal levels. To do this you may need to take oral medicines or insulin. Eating a healthy diet and getting plenty of exercise will also help.
• Getting a flu shot every year to help you avoid getting sick from the flu.

You may also need to make lifestyle changes such as:

• Quitting smoking and avoiding secondhand smoke. People who smoke have a higher risk of stroke than those who quit. Stop-smoking programs, medicines, and counseling can boost your chances of quitting for good.
• Maintaining a healthy weight. Being overweight increases your risk of developing high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
• Eating a balanced diet that is low in cholesterol, saturated fats, and salt. Fatty foods may make hardening of the arteries worse. Increase fruits and vegetables in your diet. For more information, see:

  Eating a heart-healthy diet.

• Getting regular exercise. Physical activity significantly lowers your risk of stroke. Walking is a simple way to start getting exercise. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
• Limiting alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men, and 1 drink a day for women. Excessive use of alcohol—more than 2 drinks a day—can raise your risk of stroke.

If you take warfarin, don't suddenly change your intake of foods that are rich in vitamin K. Vitamin K can interfere with the action of anticoagulants, making it more likely that your blood will clot. For more information, see:

Eating a steady amount of vitamin K when you take warfarin (Coumadin).

Watch for signs of bleeding. Call your doctor if you are taking aspirin or other medicines that slow blood clotting (such as warfarin, clopidogrel, or aspirin with extended-release dipyridamole) and you notice unusual bruising or bleeding. Follow these safety tips when taking medicines that slow blood clotting.

Treatment if the condition gets worse

If you have more than one transient ischemic attack (TIA) close together (a cluster of TIAs), you may be hospitalized because of the increased risk for stroke.

Emergency treatment for stroke is most effective if done within the first 3 hours after symptoms begin.

For more information, see the topic Stroke.

What To Think About

After you have an initial evaluation for a TIA, you may need further testing and treatment on an outpatient basis. However, because of the increased risk of stroke, staying in the hospital may be recommended for:

• People who have had more than one TIA close together (a cluster of TIAs).
• People who have had TIAs because of a heart condition, such as atrial fibrillation.
• Those who have symptoms which indicate that a large area of the brain is affected.
• Those whose symptoms last longer than an hour.
• Older adults and those with significant risk factors for stroke, such as diabetes and heart disease.

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Last updated:	May 23, 2007
Author:	Robin Parks, MS
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Karin M. Lindholm, DO - Neurology
Editors:	Kathleen M. Ariss, MS, Pat Truman