Treatment

Once your doctor has determined the cause of your transient ischemic attack, the goal of treatment is to correct the abnormality and prevent a stroke. Depending on the cause of your TIA, your doctor may prescribe medication to reduce the tendency for blood to clot or may recommend surgery or a balloon procedure (angioplasty).

Medications

Doctors use several medications to decrease the likelihood of a stroke after a transient ischemic attack. The medication selected depends on the location, cause, severity and type of TIA. Your doctor may prescribe:

• Anti-platelet drugs. These medications make your platelets, one of the circulating blood cell types, less likely to stick together. When blood vessels are injured, sticky platelets begin to form clots, a process completed by clotting proteins in blood plasma.

  The most frequently used anti-platelet medication is aspirin. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix).

  Your doctor might prescribe aspirin and clopidogrel to be taken together for about a month after the TIA. Research shows that taking these two drugs together in certain situations reduces the risk of a future stroke more than taking aspirin alone. There may be certain situations when the duration of taking both medications together may be extended, such as when the cause of the TIA is a narrowing of a blood vessel located in the head.

  Your doctor may consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. The way dipyridamole works is slightly different from aspirin.

• Anticoagulants. These drugs include heparin and warfarin (Coumadin, Jantoven). They affect clotting-system proteins instead of platelet function. Heparin is used for a short time and is rarely used in the management of TIAs.

  These drugs require careful monitoring. If atrial fibrillation is present, your doctor may prescribe a direct oral anticoagulant such as apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) or dabigatran (Pradaxa).

Surgery

If you have a moderately or severely narrowed neck (carotid) artery, your doctor may suggest carotid endarterectomy (end-ahr-tur-EK-tuh-me). This preventive surgery clears carotid arteries of fatty deposits (atherosclerotic plaques) before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed, and the artery is closed.

Angioplasty

In selected cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloon-like device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open.