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Treatments and drugs
By Mayo Clinic staff
Once your doctor has determined the cause of your transient ischemic attack, the goal of treatment is to correct the abnormality and prevent a stroke. Depending on the cause of your TIA, your doctor may prescribe medication to reduce the tendency for blood to clot or may recommend surgery or a balloon procedure (angioplasty).
Medications
Doctors use several medications to decrease the likelihood of a stroke after a transient ischemic attack. The medication selected depends on the location, cause, severity and type of TIA. Two frequently prescribed types of drugs are:
- Anti-platelet drugs. These medications make your platelets, one of the circulating blood cell types, less likely to stick together. When blood vessels are injured, sticky platelets begin to form clots, a process completed by clotting proteins in blood plasma. The most frequently used anti-platelet medication is aspirin. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix). Some studies indicate that aspirin is most effective in combination with another anti-platelet drug. Your doctor may consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. The way dipyridamole works is slightly different from aspirin. Ticlopidine (Ticlid) is another anti-platelet medication that doctors occasionally recommend.
- Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect clotting-system proteins instead of platelet function. Heparin is used short term and warfarin over a longer term. These drugs require careful monitoring.
Surgery and angioplasty (stenting)
If you have a moderately or severely narrowed neck (carotid) artery, your doctor may suggest carotid endarterectomy (end-ahr-tur-EK-tuh-me). This preventive surgery clears carotid arteries of fatty deposits (atherosclerotic plaques) before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed, and the artery is closed.
In selected cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloon-like device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open.
- Transient ischemic attack. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4781. Accessed Dec. 30, 2008.
- Wu CM, et al. Early risk of stroke after transient ischemic attack: A systematic review and meta-analysis. Archives of Internal Medicine. 2007;167:2417.
- Stroke risk factors. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4716. Accessed Dec. 30, 2008.
- Sacco RL, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke. 2006;37:577.
- NINDS transient ischemic attack information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/tia/tia.htm. Accessed Dec. 31, 2008.
- Lewandowski CA, et al. Transient ischemic attack: Definitions and clinical presentations. Annals of Emergency Medicine. 2008;52:S7.
- Ischemic stroke. http://www.merck.com/mmpe/sec16/ch211/ch211b.html?qt=transient%20ischemic%20attack&alt=sh#sec16-ch211-ch211b-446. Accessed Dec. 31, 2008.
- Sudlow C. Dipyridamole with aspirin is better than aspirin alone in preventing vascular events after ischaemic stroke or TIA. British Medical Journal. 2007;334:901.
