Ischemic Stroke / TIA Secondary Prevention — free guideline decision tool

From stroke mechanism and whether it is minor / intracranial large-artery stenosis, give the antithrombotic regimen with statin and BP targets. Instant, browser-side.

Non-cardioembolic → antiplatelet (single agent usually; clopidogrel + aspirin for 21 days after minor stroke NIHSS ≤ 3 or high-risk TIA ABCD² ≥ 4; dual for 90 days then single for symptomatic intracranial stenosis 70–99%). Cardioembolic (AF) → anticoagulation (NOAC preferred). LDL target < 1.8 mmol/L or ≥ 50% reduction with large-artery atherosclerosis; BP < 130/80 if tolerated (< 140/90 with intracranial stenosis).

Direction for secondary prevention after ischemic stroke or TIA.

Short-term dual antiplatelet (21 days) benefits minor stroke / high-risk TIA; longer dual (90 days) suits symptomatic intracranial large-artery stenosis, then de-escalate to single agent. CYP2C19 loss-of-function carriers may use ticagrelor + aspirin in place of clopidogrel-based dual therapy. High-intensity statin with LDL < 1.8 (add ezetimibe, then PCSK9i, if not at goal) for large-artery atherosclerosis. Assess CEA/CAS for symptomatic carotid stenosis 70–99%; control glucose, stop smoking, exercise.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Stroke mechanism Non-cardioembolic (atherosclerotic/small-vessel/undetermined), Minor stroke (NIHSS ≤ 3) or high-risk TIA (ABCD² ≥ 4) within 24h Yes, Symptomatic severe intracranial large-artery stenosis (70–99%) Yes, Concomitant intra-/extracranial large-artery atherosclerosis Yes → Result: Antithrombotic regimen Clopidogrel + aspirin dual antiplatelet for 21 days then switch to single agent (CYP2C19 loss-of-function carriers may use ticagrelor + aspirin for 21 days then ticagrelor monotherapy)（Statin/LDL target: High-intensity statin, lower LDL-C to < 1.8 mmol/L or by ≥ 50%; add ezetimibe if not at goal (PCSK9i if needed), Blood-pressure target: Due to intracranial large-artery stenosis: < 140/90 mmHg, Other: Glycemic control (a GLP-1RA/SGLT2i with cardio-cerebrovascular benefit may be chosen in diabetes), smoking/alcohol cessation, exercise and weight control; assess CEA or CAS for symptomatic carotid stenosis 70–99%） Inputs: Stroke mechanism Cardioembolic (AF, etc.), Minor stroke (NIHSS ≤ 3) or high-risk TIA (ABCD² ≥ 4) within 24h No, Symptomatic severe intracranial large-artery stenosis (70–99%) No, Concomitant intra-/extracranial large-artery atherosclerosis No → Result: Antithrombotic regimen Oral anticoagulation (NOAC preferred for AF and other cardioembolic causes; warfarin for mechanical valve or moderate-severe mitral stenosis)（Statin/LDL target: If non-cardioembolic and LDL-C ≥ 2.6 give high-intensity statin; with large-artery atherosclerosis the target is < 1.8, Blood-pressure target: Lower to < 130/80 mmHg if tolerated, Other: Glycemic control (a GLP-1RA/SGLT2i with cardio-cerebrovascular benefit may be chosen in diabetes), smoking/alcohol cessation, exercise and weight control; assess CEA or CAS for symptomatic carotid stenosis 70–99%）