TREATMENT PLAN, KEY INFORMATION
TREATMENT PLAN
Acute management:
- TIA within 7 days: TIA clinic within 24 hours
- TIA >7 days: TIA clinic within 7 days
- Acute stroke: immediate ED referral
- No antiplatelet/anticoagulation until stroke type confirmed
Prevention:
- Lifestyle measures
- Antiplatelets: clopidogrel (1st line)
aspirin + dipyridamole (2nd line) dipyridamole (3rd line)
- BP targets: systolic 130mmHg (140- 150mmHg if bilateral carotid stenosis) – may need to consider antihypertensives
- Lipid modification with statins – with the aim to decrease non-HDL cholesterol by more than 40% in three months – Anticoagulation if indicated
- Contraception: avoid combined oral contraceptives (offer progesterone only or nonhormonal forms)
Complications management:
- Mobility: botulinum toxin (localised), baclofen (general spasticity)
- Pain: Neuropathic – amitriptyline, pregabalin, gabapentin / MSK – Paracetamol, NSAIDs, TENS, Opioids
- Continence: pelvic/bladder exercises
- Sexual dysfunction: sildenafil (not before 3 months post-stroke)
- Mental health: psychological interventions, problem-solving therapy, motivational interventions, antidepressants
- Hearing issues: patients are screened within six weeks
- Fatigue: This is assessed using the fatigue severity scale
Follow-up:
- Post-discharge: 6-monthly then 12-monthly – DVLA:
- Single TIA – no driving for 1 month, don’t need to notify DVLA
- Multiple TIAs – no driving for 3 months, inform DVLA
- Single stroke – no driving for 1 month, inform DVLA if neurological symptoms persist
KEY INFORMATION
- Acute stroke requires immediate ED assessment
- TIA: Aspirin 300mg if within 7 days of symptoms
- No antithrombotic until stroke type is confirmed
- Regular follow-up is essential