Transient Ischaemic Attack (TIA)

G45.9

DESCRIPTION

A transient ischaemic attack is an episode of the brain, spinal cord, or retinal ischaemia causing focal neurological dysfunction usually for less than one hour. Risk of subsequent stroke is highest in the week after a TIA. Consider hypoglycemia, epilepsy and migraine as alternative causes for the symptoms.

The ABCD[2] scoring system:

Feature Points
≥ 60 years of age 1
BP ≥ 140/90 mmHg 1
Clinical features:
speech disturbance without weakness OR
unilateral weakness
1
2
Diabetes 1
Duration:
10 to 59 minutes OR
≥ 1 hour
1
2

ABCD[2] score of ≥4 is regarded as high risk and warrants urgent investigation and management as the risk of stroke within the next week is ≥4%.

MEDICINE TREATMENT

Cardioembolic disease:

  • Warfarin, oral, 5 mg daily.
    • INR should be done after 48 hours, then every 1 to 2 days until within the therapeutic range of 2 to 3 (refer to Initiation dosing tables in the Appendix II).
    • Adjust dose to keep INR within therapeutic range (refer to Maintenance dosing tables in the Appendix II).

LoEIII [13]

Other patients:

  • Aspirin, oral, 150 mg daily.

LoEI [14]

AND

  • HMGCoA reductase inhibitors (statins), e.g.:
  • Simvastatin, oral, 40 mg at night.

LoEIII [15]

Patients on protease inhibitor:

  • Atorvastatin, oral, 10 mg at night.

LoEI [16]

Patients on amlodipine (and not on a protease inhibitor):

  • Simvastatin, oral, 10 mg at night.

LoEIII [17]

If patient complains of muscle pain:

Reduce dose:

  • HMGCoA reductase inhibitors (statins), e.g.:
  • Simvastatin, oral, 10 mg at night.

LoEIII [18]

OR

Consult specialist for further management.

Manage hypertension – see Hypertension.