Transient ischaemic attack (TIA) : Treatment

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

A TIA is a warning sign that you're at increased risk of having a full stroke in the near future. The highest risk is 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 after a TIA can help to reduce your risk of having a stroke.

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

Treatments include:

  • lifestyle changes
  • medicines
  • surgery

Lifestyle changes

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

These include:

  • eating a healthy, balanced 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 activity, such as cycling or fast walking, plus strength exercises on two days 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 – men and women are advised to limit alcohol intake to 14 units per week

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Medicines

Most people who have had a TIA will need to take 1 or more medicines every day, long-term, to help reduce their chances of having a stroke or another TIA.

Aspirin and other antiplatelet medicines

You’ll probably be given aspirin straightaway after a suspected TIA.

Aspirin works as an antiplatelet medicine.

Platelets are blood cells that help blood to clot.

Antiplatelet medicines work by reducing the ability of the platelets to stick together and form clots.

You may also be given other antiplatelets such as clopidogrel or dipyridamole.

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.

Anticoagulants

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

They're usually offered to people who had a TIA that was caused by a blood clot in their heart. This is often due to a condition called atrial fibrillation, which causes your heart to beat irregularly.

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

A side effect of all anticoagulants is the risk of bleeding because these medicines reduce the blood's ability to clot. You may need regular blood tests while taking warfarin, so doctors can check your dose is not too high or too low.

Find out more about anticoagulants.

Blood pressure medicines

If you have high blood pressure, you'll be offered a type of medicine called an antihypertensive to control it. This is because high blood pressure 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 2 or more different medicines.

Find out more about treating high blood pressure.

Statins

If you have high cholesterol, you'll 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. You may be offered a statin even if your cholesterol level is not particularly high.

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

Find out more about statins.

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Surgery

In some cases, an operation 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 arteries – the main blood vessels that supply the head and neck – plus any blockage inside the carotid arteries.

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

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 when they have become moderately or severely narrowed, a carotid endarterectomy can significantly reduce the risk of having a stroke or another TIA.

Find out more about carotid endarterectomies.

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Driving after a TIA

Although a TIA shouldn't have any long-term impact on your daily activities, you must stop driving immediately.

If your doctor is happy that you have made a good recovery and there are no lasting effects after 1 month, you can start driving again.

You do not need to inform the Driver and Vehicle Licensing Agency (DVLA), but you should contact your car insurance company.

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