Transient ischemic attack
Also known as: mini-stroke · TIA
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2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack
American Heart Association / American Stroke Association (AHA/ASA) · 2021
The AHA/ASA secondary prevention guideline for people who have had an ischemic stroke or TIA. It is organised around diagnostic evaluation to establish stroke mechanism, management of vascular risk factors, cause-specific prevention strategies, and systems of care, with an emphasis on shared care planning with patients. Published in the journal Stroke in May 2021.
European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack
European Stroke Organisation (ESO) · 2021
ESO's GRADE-based guideline on how to triage, investigate and treat people with suspected transient ischaemic attack, with particular attention to the acute phase when recurrent-stroke risk is highest. It covers definitions, urgency of specialist assessment, the role and limits of risk-prediction scores, vascular and brain imaging choices, and early antithrombotic strategy. Published in the European Stroke Journal in 2021.
- Focuses on triage, investigation and secondary prevention in the acute phase after TIA. source
- Advises against relying on a risk-prediction score alone to make triage and treatment decisions in suspected TIA. source
- Listed as the 2021 TIA management guideline in ESO's official guideline directory. source
US vs EU key differences
- Use of risk scores differs: the 2021 AHA/ASA guideline uses an ABCD2 score of 4 or more as an eligibility gate for starting dual antiplatelet therapy, whereas the ESO 2021 TIA guideline explicitly advises against relying on prediction tools alone to triage patients, noting that scores below 4 still contain patients at real recurrence risk. source
- The ESO guideline makes a strong recommendation that every suspected TIA patient be seen by a stroke specialist within 24 hours of symptom onset, a service-delivery standard the US secondary-prevention guideline does not frame as a single timed target. source
- Both guidelines strongly endorse short-course aspirin plus clopidogrel started within 24 hours for high-risk non-cardioembolic TIA, but the stated duration differs in emphasis: ESO cites roughly 10-21 days before switching to monotherapy, while the AHA/ASA guideline states 21 to 90 days. source
- The US guideline additionally offers a ticagrelor-plus-aspirin option for 30 days in selected patients (NIHSS 5 or less, ABCD2 6 or more, or at least 30% symptomatic stenosis), a pathway absent from the 2021 ESO TIA guideline. source
What changed recently
- US2014 → 20212021-05-24
The 2021 secondary-prevention guideline reorganised recommendations around the specific cause of the index stroke or TIA, added a new requirement to complete the diagnostic work-up within 48 hours of symptom onset, endorsed percutaneous PFO closure in selected younger patients with non-lacunar stroke, and advised against angioplasty/stenting as first-line therapy for severe intracranial stenosis in favour of aggressive medical management plus short-term dual antiplatelet therapy.
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