Patient handout

Transient ischemic attack (TIA)

PRODUCTION

1. Your condition

This handout is for transient ischemic attack (tia). Your care team identified this based on: transient focal neurologic deficit (resolved or resolving) per aha/asa 2021.

Other reasons your team may use this plan: transient monocular blindness (amaurosis fugax) per aha/asa 2021; transient aphasia / expressive or receptive (aha/asa 2021); transient hemiparesis or hemisensory loss (aha/asa 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	325 mg load → 81 mg	PO	load once → 81 mg daily maintenance	Foundational antiplatelet per AHA/ASA 2021; load 325 mg if not already on aspirin; 81 mg lifelong
clopidogrel	600 mg load → 75 mg	PO	load once → 75 mg daily × 21 d	CHANCE / POINT — DAPT × 21 d (POINT: 21 d optimal, after which bleeding risk exceeds benefit) then aspirin alone
ticagrelor	180 mg load → 90 mg BID	PO	BID × 30 d	THALES Johnston NEJM 2020 — ticagrelor + aspirin × 30 d non-inferior; useful if CYP2C19 LOF (e.g., East Asian)

Plan: Acute antithrombotic for TIA (within 24 h of symptom onset)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — no new neurologic symptoms; on full secondary prevention per AHA/ASA 2021

If you have:

No new weakness, speech change, vision change, dizziness, or balance problem (AHA/ASA 2021)
BP at goal (<130/80 per AHA/ASA 2021)
Taking all medications as prescribed (AHA/ASA 2021)

Do this:

Take aspirin (or clopidogrel or DOAC) every day exactly as prescribed per AHA/ASA 2021
Take statin every day (SPARCL)
Take BP and DM medications as prescribed (AHA/ASA 2021)
Daily home BP check (AHA/ASA 2021)
Avoid smoking; limit alcohol; follow diet + exercise plan per AHA/ASA 2021
Keep neurology + PCP appointments (AHA/ASA 2021)

YELLOW — Caution — vascular risk drift or non-focal symptoms

If you have:

Home BP persistently ≥140/90 or running high (AHA/ASA 2021)
Missed medication doses (AHA/ASA 2021)
New non-focal symptoms (general dizziness, fatigue, headache) per AHA/ASA 2021
New irregular pulse / palpitations (possible AF per AHA/ASA 2021)

Do this:

Confirm medication adherence (AHA/ASA 2021)
Check BP technique and recheck (AHA/ASA 2021)
Avoid OTC meds that raise BP (NSAIDs, decongestants) per AHA/ASA 2021
Call PCP / neurology within 24-48 h (AHA/ASA 2021)

Call your provider if:

BP persistently above goal (AHA/ASA 2021)
New irregular pulse (AF screen per AHA/ASA 2021)
Missed multiple doses of antithrombotic (AHA/ASA 2021)

RED — Medical alert — call 911 immediately for BE-FAST

If you have:

B — Balance: sudden loss of balance or coordination (AHA/ASA 2021 BE-FAST)
E — Eyes: sudden vision change in one or both eyes, double vision (AHA/ASA 2021 BE-FAST)
F — Face: face drooping on one side, uneven smile (AHA/ASA 2021 BE-FAST)
A — Arms: sudden weakness or numbness on one side (AHA/ASA 2021 BE-FAST)
S — Speech: slurred speech, cannot speak, or trouble understanding (AHA/ASA 2021 BE-FAST)
T — Time: note the time symptoms started — call 911 immediately (AHA/ASA 2021 BE-FAST)
Sudden severe headache, confusion, or trouble swallowing (AHA/ASA 2021)

Do this:

Call 911 / emergency services immediately — do NOT drive yourself (AHA/ASA 2021)
Note the EXACT time symptoms started (last known well) per AHA/ASA 2021
Do not eat or drink (AHA/ASA 2021)
Do not take aspirin or any new medication unless told by 911 dispatcher (AHA/ASA 2021)
Bring medication list (AHA/ASA 2021)

Call your provider if:

Any BE-FAST symptom — call 911, do not wait (AHA/ASA 2021)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Persistent focal neurologic deficit at presentation (NIHSS >0) per AHA/ASA 2021(life-threatening)
ABCD2 score ≥4 (Johnston Lancet 2007)
Symptomatic carotid stenosis ≥50% on duplex / CTA / MRA (AHA/ASA 2021)
New AF on telemetry / Holter / MCT / ILR (AHA/ASA 2021)
Recurrent TIA or progression to stroke after starting therapy (AHA/ASA 2021)(life-threatening)
Hemorrhage on non-contrast CT (AHA/ASA 2021)(life-threatening)

5. Follow-up

Neurology / vascular clinic at 1–2 wks per AHA/ASA 2021; PCP at 1–4 wks; cardiac rehab if appropriate; vaccinations; depression screen

6. Sources

Guideline: 2021 AHA/ASA Stroke Prevention Guidelines (after stroke / TIA) + 2024 AHA Primary Prevention of Stroke