🧠 Ischemic Stroke / TIA Secondary Prevention
From stroke mechanism and whether it is minor / intracranial large-artery stenosis, give the antithrombotic regimen with statin and BP targets. Instant, browser-side.
Ischemic Stroke / TIA Secondary Prevention
Stroke mechanism
Minor stroke (NIHSS ≤ 3) or high-risk TIA (ABCD² ≥ 4) within 24h
Symptomatic severe intracranial large-artery stenosis (70–99%)
Concomitant intra-/extracranial large-artery atherosclerosis
When to use
Direction for secondary prevention after ischemic stroke or TIA.
How it works
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).
Key points
- 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.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.