Patient handout

Transient Ischemic Attack

PRODUCTION

1. Your condition

This handout is for transient ischemic attack. Your care team identified this based on: transient focal neurological deficit fully resolved at presentation (aha/asa 2021).

Other reasons your team may use this plan: transient aphasia / dysarthria resolved (aha/asa 2021); transient hemiparesis / facial droop resolved (aha/asa 2021); transient monocular vision loss (amaurosis fugax) — anterior circulation carotid origin (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	162-325 mg PO loading × 1, then 81 mg PO daily	PO	load then daily	IST 1997 / CAST 1997 — early aspirin reduces recurrent stroke; AHA/ASA 2021 Class I

Plan: Acute TIA antiplatelet + lipid + BP + AF-anticoag bundle (AHA/ASA 2021)

3. When to call your provider

Contact your care team if any of the following happen:

Any new TIA-spectrum event → ED immediately (AHA/ASA 2021)
BP persistently >140/90 despite 3-drug regimen → resistant HTN workup (cardio.htn.resistant.v1)
AF newly detected on outpatient monitor → start DOAC per 2024 ESC AF
PHQ-9 ≥15 OR suicidal ideation → urgent psych referral
Statin intolerance → ezetimibe + PCSK9i (2026 ACC/AHA Lipid)
DOAC bleeding → temporary hold, reversal if life-threatening (idarucizumab / andexanet), reassess

4. When to seek emergency care

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

ABCD2 ≥4 OR ABCD3-I high-risk; or carotid stenosis ≥50% symptomatic; or AF detected; or crescendo TIA — admit + STAT workup + DAPT (AHA/ASA 2021 Class I)
Crescendo TIA (≥2 episodes within 24 h) OR recurrent TIA within 7 d — admit always regardless of ABCD2 (AHA/ASA 2021 Class I)
TIA + AF detected on ECG / telemetry / Holter / ILR → DOAC per 1-3-6-12 day rule by NIHSS severity (CHA2DS2-VASc auto-≥2 with TIA) (2024 ESC AF; ARISTOTLE PMID 21870978)
Symptomatic carotid stenosis ≥50% on ipsilateral side (NASCET measurement) → CEA/CAS within 14 d (AHA/ASA 2021 Class I)
Clinically diagnosed TIA + DWI-positive infarct on MRI — re-classify as minor stroke; route to neuro.ischaemic-stroke.v1; eligible for DAPT × 21 d if NIHSS ≤3 (AHA/ASA 2021)

5. Follow-up

Secondary prevention: BP <130/80 (2025 AHA/ACC HTN); LDL <55-70 (2026 ACC/AHA Lipid); DOAC adherence; smoking cessation; HbA1c <7% if DM; mRS / NIHSS check; CEA/CAS surveillance if performed (AHA/ASA 2021)

6. Sources

Guideline: 2021 AHA/ASA Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack + 2024 ESC AF + 2025 AHA/ACC HTN + 2026 ACC/AHA Dyslipidemia + ADA 2026