Treating a transient ischaemic attack

Although the symptoms of a transient ischaemic attack (TIA) resolve ina few minutes or hours without any specific treatment, you will need treatment to help prevent another TIA or a full Heat exhaustion and heatstroke occurring in the future.

A TIA is a warning sign that you are at a significantly increasedrisk of having a full stroke in the near future,with the highest riskin the days and weeks following the attack.

A stroke is a serious health condition thatcan cause permanent disability and can befatal in some cases, but appropriate treatment following a TIA can help to reduce your risk of having one.

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

Its likely that you will be advised about lifestyle changesyou can make to reduce yourstroke risk, in addition to being offered medication to treat the underlying cause of yourTIA.

You may also need surgery as part of your treatment.

Lifestyle changes

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

These include:

• eating a healthy 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 aerobic activity, such as cycling or fast walking, 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 you should aim not to exceed the recommended alcohollimits ofthree to fourunits a dayfor men andtwo to threeunits a day for women

If a blood vessel is damaged, platelets stick together to form a blood clot to prevent bleeding.

Antiplatelet medicines work by reducing the ability of the platelets to stick together and form clots. If you have had a TIA, it is likely that you willbe offered antiplatelet medication.

Two common antiplatelets offered to people who have had a TIA areaspirin and clopidogrel. Aspirin may also sometimes be taken withanother antiplatelet medicine called dipyridamolebecause this can be more effective than taking these medications separately.

The main side effects of antiplatelet medications include indigestion and anincreased risk of bleeding for example, you may bleed for longer if you cut yourself, and you may bruise easily.

This is often due to a condition called atrial fibrillation , which causes your heart to beat irregularly.

Warfarin , rivaroxaban, dabigatran and apixaban are examples of anticoagulantsofferedto some people who havehad a TIA.

A side effect of all anticoagulants is the risk of bleeding caused by the reduction in the blood's ability to clot. You may need regular blood tests while taking warfarin, so doctors can ensure your dose is not too high or too low.

This is because high blood pressure significantly increases your risk of having a TIA or stroke.

There are lots of different types of medicine thatcan help controlyour 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 two or three different medications.

Statins reduce the level of cholesterol in your blood by blocking an enzyme in the liver that produces cholesterol.

Statins may alsohelp to reduce your risk of a stroke whatever your cholesterol level is, so you may be offered a statin even if your cholesterol level is not particularly high.

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

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

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 in people whose arteries are moderately or severely narrowed, acarotid endarterectomy can significantly reduce the risk of having a stroke or anotherTIA.

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