Transient Ischemic Attack (TIA)
What is a transient ischemic attack (TIA)?
Some people call a transient ischemic attack (TIA) a mini-stroke, because the symptoms are like those of a stroke but do not last long. A TIA happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage.
A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911. Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.
What are the symptoms?
Symptoms of a TIA come on suddenly.
- One side of your body may feel numb, tingly, or heavy.
- You may not be able to move your arm, your leg, or your face on one side of your body.
- Things may look blurry or dim. You may have double vision or not be able to see.
- It may be hard to speak. You may slur or mix up your words.
- It may be hard to understand words.
- You may feel unsteady, dizzy, or clumsy. You may have trouble walking.
What causes a transient ischemic attack?
A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. Once the clot dissolves, blood flow returns, and the symptoms go away.
Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a "low-flow" TIA. It is not as common as other types.
See a picture of a transient ischemic attack.
What tests do I need after a TIA?
Your doctor will do tests to look at your heart and blood vessels. You may need:
- Tests that show pictures of your brain and blood vessels, such as a CT scan, an MRI, a magnetic resonance angiogram (MRA), or an angiogram.
- A test that uses sound to check your blood flow (Doppler ultrasound).
- An echocardiogram (echo) to check your heart's shape and its blood flow.
- An electrocardiogram (EKG, ECG) to measure your heart rhythm.
Your doctor will also check to see if something else is causing your symptoms.
How is it treated?
Your doctor will start you on medicines to help prevent a stroke. You may need to take several medicines.
If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may need surgery to open them up (carotid endarterectomy). This can help prevent blood clots that block blood flow to your brain. Another type of surgery is carotid artery stenting. During this surgery, the doctor puts a small tube called a stent inside your carotid artery. This helps keep the artery open. Carotid artery stenting is not as common as endarterectomy.
You can do a lot to reduce your chance of having another TIA or a stroke. Medicines can help, but you may need to make lifestyle changes too.
- Keep your blood pressure and cholesterol under control.
- If you have diabetes, keep your blood sugar in a target range.
- Take a daily aspirin or other medicines, if your doctor advises it.
- Take your medicines just as your doctor says to.
- Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
- Get plenty of exercise.
- Stay at a healthy weight.
- If you smoke, quit. Avoid secondhand smoke too.
- Limit alcohol. Having more than 2 drinks a day raises the risk of stroke.
- Avoid getting sick from the flu. Get a flu shot every year.
Frequently Asked Questions
Learning about TIA:
Living with TIA:
Health Tools help you make wise health decisions or take action to improve your health.
|Decision Points focus on key medical care decisions that are important to many health problems.|
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|Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?|
Blood clots that temporarily block blood flow to the brain are the most common cause of transient ischemic attacks (TIAs). Blood clots may develop for a variety of reasons.
- A blood clot can form in an artery that
supplies blood to the brain.
- Blood clots usually form in arteries damaged by plaque buildup, which is a process called atherosclerosis.
- Long-standing high blood pressure or diabetes may damage smaller blood vessels in the brain, causing a clot to form within the blood vessels and block blood flow. See a picture of how high blood pressure damages arteries.
- A blood clot can form in another part of the body (often the heart) and travel through the bloodstream to an artery that supplies blood to the brain. For example, clots may form:
In addition, an artery that is partially blocked with plaque can reduce blood flow to the brain and cause symptoms.
Rare causes of blood clots that can cause a TIA include:
- Clumps of bacteria, tumor cells, or air bubbles that move through the bloodstream.
- Conditions that cause blood cells to stick together. For example, having too many red blood cells (polycythemia), abnormal clotting factors, or abnormally shaped red blood cells, such as those caused by sickle cell disease, may cause blood clots to form.
- Inflammation in the blood vessels, which may develop from conditions such as syphilis, tuberculosis, or other inflammatory diseases.
- A head or neck injury that results in damage to blood vessels in the head or neck.
- A tear in the wall of a blood vessel located in the neck.
Symptoms of transient ischemic attacks (TIAs) develop suddenly and are always temporary. They usually go away within 10 to 20 minutes. TIA symptoms are just like stroke symptoms. They vary depending on which part of the brain is affected. Common symptoms of TIA include:
- Weakness on one side of your body or an inability to move a part or all of one side of your body, such as your face, arm, and leg.
- Numbness, tingling, or a feeling of heaviness on one side of your body.
- Trouble seeing, such as blurring or double vision, dimness, or a sensation that a shade has been pulled down over the eyes.
- Trouble speaking or finding words.
- Trouble understanding words.
- Vertigo , unsteadiness, dizziness, clumsiness, staggering, or fainting. You may have trouble walking. You may also have a drop attack, which is a sudden loss of strength in your legs.
It is not always easy to recognize a transient ischemic attack (TIA) because you may think that the symptoms are caused by normal aging or other conditions. But you should treat any symptoms of a TIA as an emergency because you have no way to know whether they are from a stroke or a TIA.
Symptoms of a transient ischemic attack (TIA) usually go away within 10 to 20 minutes, but some can last longer. If symptoms last longer than an hour, it might be more likely that you have had a stroke.
TIA symptoms, which are caused by a blood clot that temporarily reduces blood flow to the brain, disappear when the blood clot dissolves and blood flow returns.
A TIA is a warning sign that a stroke may soon follow. Any symptoms of a TIA need to be treated as an emergency.
- Of those who survive a first TIA or stroke, 14% will have another TIA or stroke within 1 year.1
- A cluster of TIAs that increase in frequency, become more severe, or last longer is a sign that a stroke may soon occur.
A TIA also may signal an increased risk for a heart attack. Atherosclerosis, which is hardening of the arteries, affects blood vessels throughout the body, including arteries that supply blood to the heart and brain. Atherosclerosis that affects the blood vessels in the heart (coronary arteries) may cause chest pain or a heart attack.
What Increases Your Risk
Risk factors you can change
Risk factors for TIA that you can change are:
- High blood pressure .
- Smoking and regular exposure to secondhand smoke, which are strong risk factors for stroke, TIA, and heart attack.2
- High cholesterol.
- High triglycerides.3
- Excessive use of alcohol .
- Use of birth control pills, especially in women who smoke or have a history of blood clots.
- Lack of exercise.
- Use of cocaine.
Risk factors you cannot change
Risk factors for TIA that you cannot change are:
- Age: Most TIAs happen after the age of 60.
- Family history: People with a family history of TIA or stroke are at higher risk.
- Prior history of TIA: People who have had a TIA are more likely to have another TIA or a stroke.
Diseases that increase the risk for TIA
Your risk for TIA increases if you have diseases such as:
- High blood pressure.
- Diabetes .
- Hardening of the arteries (atherosclerosis), especially of the carotid arteries.
- Atrial fibrillation and certain other heart conditions, such as coronary artery disease, heart failure, or heart valve disorders.
- Conditions that cause blood cells to stick together and form clots, such as having too many red blood cells (polycythemia), abnormal clotting factors, or abnormally shaped red blood cells, such as those caused by sickle cell disease.
When To Call a Doctor
Call 911 or other emergency services immediately if you have:
- Sudden numbness, tingling, or weakness in or an inability to move part or all of one side of your body, such as your face, arm, and leg.
- Brief vision changes that come on suddenly, such as dimness, blurring, double vision, or loss of vision in one or both eyes (usually described as a feeling that a shade is being pulled down over your eyes).
- Sudden difficulty speaking.
- Sudden difficulty understanding words.
- Sudden dizziness, clumsiness, staggering, trouble walking, or a drop attack.
- Sudden, severe headache that is different from previous headaches and is without a known cause.
Call your doctor immediately if you have:
- Recently had symptoms of a transient ischemic attack (TIA), and the symptoms have completely disappeared.
- Had a TIA or stroke while taking aspirin or other medicine that prevents blood clots, and you notice any signs of bleeding.
Call your doctor today if you think you have had a TIA in the past and have not yet talked with your doctor about your symptoms.
Taking a wait-and-see approach, called watchful waiting, is not appropriate if you are having symptoms of a TIA. Any symptoms of a TIA need to be considered a medical emergency. Seek medical assistance immediately.
Who To See
The following doctors can diagnose and treat a transient ischemic attack (TIA):
Other specialist(s) may be consulted if you need surgery or have other health problems:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Immediate evaluation is recommended if you have had or are having a transient ischemic attack (TIA). The purpose of evaluation is to:
- Check for another cause of your symptoms, such as a stroke, low blood sugar (if you have diabetes), or Bell's palsy.
- Look for a blood clot.
- Determine whether you need surgery to reopen a blocked artery (carotid endarterectomy).
- Determine whether you need medicines to prevent blood clots.
If a TIA is suspected, the doctor may want to do tests, such as a:
- CT scan of the head, to check for bleeding in the brain when symptoms of a TIA are occurring and to check for evidence of a stroke or other disease, such as a tumor.
- MRI scan, to check for damage to the brain from a stroke.
Further tests are often done to identify the underlying cause of the TIA. If blockage of the carotid arteries is suspected, you may have tests such as:
- A Doppler ultrasound.
- A magnetic resonance angiogram (MRA). See a picture of a TIA angiogram.
- An angiogram of your head and neck.
TIA symptoms may be due to blood clots caused by a heart problem. If heart problems are suspected, you may have tests such as a:
- Chest X-ray to assess the size and shape of your heart.
- Electrocardiogram (ECG, EKG) or Holter monitoring or ambulatory EKG to assess heart rhythm.
- Echocardiogram (echo) to examine the shape of the heart chambers and blood flow through them.
- Cholesterol and triglycerides tests to check the level of these blood fats that can increase your risk for blood clots and hardening of the arteries.
You may have other blood tests, such as a complete blood count (CBC), based on your age and medical history. Your doctor will use these tests to look for other causes of the TIA.
If you have had a transient ischemic attack (TIA), you will probably need to take a medicine to help prevent blood clots. If the carotid arteries in your neck are significantly blocked, you may also need to have surgery to reopen the narrowed arteries. In addition, if you have high blood pressure, diabetes, or high cholesterol, you will also need treatment for those diseases.
If you have symptoms of a transient ischemic attack (TIA), seek medical help immediately. If your symptoms have gone away, contact your doctor as soon as possible. A TIA is a sign that a stroke may soon follow, and prompt medical treatment may prevent a stroke. About 14% of people who survive a first TIA or stroke will have another TIA or a stroke within a year.1
You will need to take medicine that will reduce the risk of future blood clots. These medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.
If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). Endarterectomy surgery also may be appropriate for some people who have not had a TIA but who have significant narrowing in an artery.
Another option to reopen narrowed carotid arteries is angioplasty with stenting. This procedure is much like the one used to open up clogged heart arteries. A doctor threads a thin tube called a catheter through an artery and up to the carotid arteries in your neck, and then he or she inflates a tiny balloon to enlarge the narrowed artery. The doctor places a wire mesh device called a stent in the artery to keep it open. Carotid artery stenting is not as common as endarterectomy.
Ongoing treatment will focus on preventing another transient ischemic attack (TIA) or stroke and reducing additional risk factors for stroke. This may include:
- Reducing high blood pressure, the most common risk factor for stroke, by making changes to your diet and taking blood pressure–lowering medicines.
- Taking aspirin or another antiplatelet medicine to prevent strokes. It has been shown that people who have had a stroke, a TIA, or an endarterectomy may benefit from taking aspirin or another antiplatelet medicine, such as aspirin with extended-release dipyridamole, daily to prevent another stroke.
- Taking anticoagulant medicines, which are commonly called blood thinners, if you have atrial fibrillation. People with atrial fibrillation who have had a TIA usually need to take anticoagulants, such as warfarin (Coumadin, for example) to reduce their risk of stroke. Studies show that anticoagulants are better than antiplatelet medicines (like aspirin) at preventing strokes for this group of people.4 Some people cannot take anticoagulants, however. In this case, you will probably be given another medicine to reduce your chance of having a stroke.
- Taking medicines such as statins to lower high cholesterol. Many studies show that statins significantly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.5
- Controlling diabetes. Your doctor will advise that you try to keep your blood sugar levels in a target range. To do this you may need to take oral medicines or insulin. Eating a healthy diet and getting plenty of exercise will also help.
- Getting a flu shot every year to help you avoid getting sick from the flu.
You may also need to make lifestyle changes such as:
- Quitting smoking and avoiding secondhand smoke. People who smoke have a higher risk of stroke than those who quit. Stop-smoking programs, medicines, and counseling can boost your chances of quitting for good.
- Maintaining a healthy weight. Being overweight increases your risk of developing high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
- Eating a balanced diet that is low in cholesterol, saturated fats, and salt. Fatty foods may make hardening of the arteries worse. Increase fruits and vegetables in your diet. For more information, see:
- Getting regular exercise. Physical activity significantly lowers your risk of stroke. Do activities that raise your heart rate. Try to do moderate activity, such as brisk walking, at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.6
- Limiting alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men, and 1 drink a day for women. Excessive use of alcohol—more than 2 drinks a day—can raise your risk of stroke.
If you take warfarin, you need to take extra steps to avoid bleeding problems. For more information see:
Treatment if the condition gets worse
If you have more than one transient ischemic attack (TIA) close together (a cluster of TIAs), you may be hospitalized because of the increased risk for stroke.
Emergency treatment for stroke is most effective when it is given right away after symptoms begin.
For more information, see the topic Stroke.
What To Think About
After you have an initial evaluation for a TIA, you may need further testing and treatment on an outpatient basis. But because of the increased risk of stroke, staying in the hospital may be recommended for:
- People who have had more than one TIA close together (a cluster of TIAs).
- People who have had TIAs because of a heart condition, such as atrial fibrillation.
- Those who have symptoms which indicate that a large area of the brain is affected.
- Those whose symptoms last longer than an hour.
- Older adults and those with significant risk factors for stroke, such as diabetes and heart disease.
- Have regular medical checkups. Work with your doctor to control high blood pressure, high cholesterol, heart disease (especially atrial fibrillation), diabetes, and disorders that affect blood vessels and how your blood clots, such as polycythemia and sickle cell anemia.
- Quit smoking. Daily cigarette smoking can increase the risk of stroke by 2½ times.7 Regular exposure to secondhand smoke also increases your risk of stroke.2
- Check with your doctor about whether you should take an aspirin each day and medicine to lower your cholesterol, if you have been told that you have hardening of the arteries (atherosclerosis). It has been shown that for people who have had a stroke, a TIA, or an endarterectomy, daily taking aspirin or other antiplatelet medicines, such as aspirin with extended-release dipyridamole, may help prevent another stroke.
- Ask your doctor about taking cholesterol-lowering medicines such as statins if you have high cholesterol or have had a heart attack.
- If you have had a prior TIA, taking blood pressure-lowering medicines may help prevent another TIA or stroke.8
- Maintain a healthy weight. Being overweight increases your risk for high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
- Eat a balanced diet that is low in cholesterol, saturated fats, and salt. Eat a variety of fruits and vegetables. Fatty foods may make hardening of the arteries worse. For more information, see:
- Get regular exercise, and reduce your stress. Do activities that raise your heart rate. Try to do moderate activity at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week.6
- Limit alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men, and 1 drink a day for women. Excessive use of alcohol (more than 2 drinks a day) can raise your risk of stroke.
- Avoid taking birth control pills (oral contraceptives) if you have other risk factors for TIA or stroke, such as smoking, high cholesterol, or a history of blood clots. Talk to your doctor about other forms of birth control that do not increase your risk of TIA and stroke.
- Avoid getting sick from the flu. Get a flu shot every year.
Because atrial fibrillation increases your risk of stroke and because many people do not have symptoms of atrial fibrillation, the National Stroke Association recommends that everyone, particularly those age 55 or older, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.
If you are age 55 or older and have atrial fibrillation, you can use this tool to check your risk of stroke: Interactive Tool: Stroke Risk From Atrial Fibrillation.
Home treatment is not appropriate for a transient ischemic attack (TIA). If you think you are having a TIA, do not ignore the symptoms and do not try to manage them at home. Seek emergency medical care when symptoms first appear. Prompt treatment may keep you from having a stroke.
If you have had a TIA recently:
- Follow your treatment plan to help prevent another TIA or stroke.
- Call your doctor if you notice unusual bruising or bleeding and you are taking aspirin or other medicines that slow blood clotting (such as warfarin, clopidogrel, or aspirin with extended-release dipyridamole). If you take warfarin, you need to take extra steps to avoid bleeding problems. For more information, see:
- Work with your doctor to control any medical conditions that may increase your risk of having another TIA or stroke, such as high blood pressure, atrial fibrillation, high cholesterol, or diabetes.
- Eat a healthy, balanced diet. For more information, see:
- Stay at a healthy weight.
- Do not smoke. (For more information on how to quit, see the topic Quitting Smoking.) Avoid secondhand smoke too.
- Get regular exercise.
- Limit alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men, and 1 drink a day for women.
- Avoid getting sick from the flu. Get a flu shot every year.
Your doctor will probably prescribe several medicines after you have had a transient ischemic attack (TIA). Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.
The types of medicines that prevent clotting are:
- Antiplatelet medicines.
- Anticoagulant medicines.
Cholesterol-lowering and blood pressure-lowering medicines are also used to prevent TIAs and strokes.
- Aspirin is most often used to prevent TIAs and strokes. Many studies have shown that aspirin helps prevent strokes and reduces the risk of another TIA in people who have had their first TIA.
- Other antiplatelet medicines (such as clopidogrel) may be used for people who cannot take aspirin or for whom aspirin has not been effective.
- Aggrenox, a medicine that combines aspirin with dipyridamole, is a safe and effective alternative to aspirin to prevent TIA and stroke for some people.9
Anticoagulants prevent the production of certain proteins that are needed for blood to clot. If you have atrial fibrillation, you will probably take an anticoagulant (such as warfarin). Anticoagulants are more effective than antiplatelets in preventing strokes in people with atrial fibrillation.4
Both anticoagulants and antiplatelets increase the risk of bleeding. Warfarin (such as Coumadin) has the highest risk of bleeding problems, but the risk is lower when the dosage is closely monitored.
If you take warfarin, you need to take extra steps to avoid bleeding problems. For more information, see:
Experts recommend that most people who have had a TIA take statins, which lower cholesterol. Many studies show that statins significantly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.5 For more information on these medicines, see the topic High Cholesterol.
If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgical procedure, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA and how much your carotid arteries have narrowed.
You are most likely to benefit from surgery if you have had a TIA in the past 6 months and you have 70% or greater narrowing in one of your carotid arteries. Carotid endarterectomy may also be appropriate if your carotid arteries are moderately or severely blocked (50% to 70%) and you have had one or more TIAs.10 Talk to your doctor about whether a carotid endarterectomy is right for you.
A relatively new procedure called carotid artery stenting is another option for some people who are at high risk of stroke. This procedure is much like coronary angioplasty, which is commonly used to open blocked arteries in the heart. During this procedure, a vascular surgeon inserts a metal tube called a stent inside your carotid artery to increase blood flow in areas blocked by plaque. The surgeon may use a stent that is coated with medicine to help prevent future blockage. Carotid artery stenting is not as common as endarterectomy.
Each person must carefully weigh the benefits and risks of surgery and compare them with the benefits and risks of using medicine to reduce the risk of TIA or stroke. The success of either treatment will depend on the amount of blockage you have and which medicine you use. Risks of surgery depend on your age, your health status, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.
What To Think About
Carotid endarterectomies are most successful when they are done by a surgeon who is well trained in the procedure and in a hospital that is well equipped to take care of any complications that may occur during or after the procedure.
If you are considering carotid endarterectomy, ask the hospital or state medical board about the number of times complications have occurred in people that your doctor has treated with this surgery and the complication rate at the hospital where the surgery is to be done. The American Heart Association Stroke Council recommends that surgery be performed by a surgeon who has complications in less than 3% of those treated and that the hospital rate of complications be just as low.10
While carotid endarterectomy is often not done until several months after a TIA, a large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke because people are more likely to have a stroke in the first few days and weeks after a TIA. These results also point out why it is so important to see a doctor immediately if you have any signs of TIA.11
Carotid artery stenting is a procedure similar to one commonly used to open narrowed arteries in the heart. Angioplasty combined with a stent is now being done as an alternative to surgery for preventing transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid arteries in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a wire mesh stent to keep the artery open. Carotid artery stenting is not as common as carotid endarterectomy.
Other Places To Get Help
|National Institute of Neurological Disorders and Stroke|
|P.O. Box 5801|
|Bethesda, MD 20824|
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.
|American Heart Association (AHA)|
|7272 Greenville Avenue|
|Dallas, TX 75231|
Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.
|National Heart, Lung, and Blood Institute (NHLBI)|
|P.O. Box 30105|
|Bethesda, MD 20824-0105|
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
|National Stroke Association|
|9707 East Easter Lane, Building B|
|Centennial, CO 80112|
This association provides education, information, referrals, and research on stroke. Information specific to survivors, caregivers, family, women, and children is included.
- American Heart Association (2006). Heart disease and stroke statistics—2006 update. Circulation, 113(6): e85–e151.
- Pearson TA, et al. (2002). AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation, 106(3): 388–391.
- Tanne D, et al. (2001). Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) registry: High triglycerides constitute an independent risk factor. Circulation, 104(24): 2892–2897.
- Saxena R, Koudstall PJ (2006). Anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-rheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
- Stroke Council (2004). Statins after ischemic stroke and transient ischemic attack: An advisory statement from the Stroke Council, American Heart Association and American Stroke Association. Available online: http://stroke.ahajournals.org/cgi/content/full/35/4/1023.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
- Kasner SE, Morgenstern LB (2004) Cerebrovascular disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 4. New York: WebMD.
- PROGRESS Collaborative Group (2001). Randomised trial of a perindopril-based blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet, 358(9287): 1033–1040.
- ESPRIT Study Group (2006). Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): A randomized controlled trial. Lancet, 367(9523): 1665–1673.
- Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.
- Rothwell PM, et al., (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363(9413): 915–924.
Other Works Consulted
- American Heart Association and American College of Cardiology (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation, 113(19): 2363–2372. [Erratum in Circulation, 113(22): 847.]
- Brust J (2005). Transient ischemic attack. In LP Rowland, ed., Merritt's Neurology, 11th ed., pp. 293–295. Philadelphia: Lippincott Williams and Wilkins.
- Gami A (2006). Secondary prevention of ischaemic cardiac events, search date July 2004. Online version of Clinical Evidence (15): 1–31.
- Hirsch J, et al. (2008). Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th ed.). Chest, 133(6): 71S–109S.
- Sacco RL, et al. (2006). Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke, 37(2): 577–617.
|Editor||Kathleen M. Ariss, MS|
|Associate Editor||Pat Truman, MATC|
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Specialist Medical Reviewer||Karin M. Lindholm, DO - Neurology|
|Last Updated||November 11, 2009|
Last Updated: November 11, 2009