All patients with a TIA with full recovery:
- Prescribe aspirin 300mg once daily for 14 days
- Followed by clopidogrel 75mg once daily, long term
High risk TIA (ABCD2 score 4 to 7) with full recovery:
- The high risk TIA regimen should occur following a CT scan, and be instituted by a stroke physician
- Consider clopidogrel 300mg loading dose after initial aspirin loading
- Followed by dual antiplatelet therapy (DAPT): clopidogrel 75mg and aspirin 75mg once daily, for 21 days
- After 21 days, stop aspirin and continue clopidogrel 75mg monotherapy long term
Stroke:
- All patients with a confirmed stroke should be referred to the stroke service
- A stroke consultant will review the patient to decide if they are classed as a minor or moderate/severe ischaemic stroke. These patients require brain imaging prior to commencing secondary prevention.
- Once haemorrhage is excluded:
- Minor ischaemic stroke patients receive the same DAPT regimen as high risk TIA’s, including clopidogrel loading dose
- Moderate/severe ischaemic stroke patients receive aspirin 300mg once daily for 14 days, and thereafter they will usually be converted to clopidogrel 75mg daily
- If already on clopidogrel, eg for coronary artery stent, seek stroke specialist advice before switching to aspirin
- If already on aspirin 75mg daily, then increase dose to 300mg daily for 14 days, depending on presentation and diagnosis
- If already on warfarin or other oral anticoagulant, see anticoagulant advice below
- If thrombolysed, initiate aspirin 300mg 24 hours after thrombolysis and repeat CT scan.
Prescribing information |
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