TIA · ABCD2 Risk Stratification Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] ABCD2 score
   Which ABCD2 band after TIA? (ABCD2 (7 points): age ≥60 (1); BP ≥140/90 (1); clinical — unilateral weakness (2) / speech disturbance without weakness (1); duration — ≥60 min (2) / 10–59 min (1) / <10 min (0); diabetes (1). 0–3 low, 4–5 moderate, 6–7 high risk (increasing 2/7/90-day stroke risk).)
   • Moderate–high (4–7) → Moderate–high risk
   • Low (0–3) → Low risk
2. [End] Moderate–high risk
   Urgent ED/stroke-specialist evaluation: brain + vascular imaging as soon as possible (MRI-DWI, carotid assessment). Antiplatelet — high-risk minor stroke/TIA may have short-term dual antiplatelet (aspirin + clopidogrel for 21 days, per CHANCE/POINT); control BP and glucose, statin; anticoagulate if AF; symptomatic carotid stenosis 70–99% → endarterectomy/stenting within 2 weeks.
3. [End] Low risk
   Low risk (0–3) still needs prompt evaluation and secondary prevention: antiplatelet, work-up (imaging, carotids, rhythm/AF), control risk factors. ABCD2 alone should not decide admission; most guidelines now favor rapid evaluation of all TIAs, with immediate ED return for any deterioration or recurrence.

Source guidelines & references

• Johnston SC, Rothwell PM, et al. ABCD2 score to predict stroke risk after TIA. Lancet 2007
• CHANCE (NEJM 2013) / POINT (NEJM 2018) short-term dual antiplatelet trials

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways