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TIA symptoms typically last < 1 - 2 hours
Duration of symptoms is an unreliable discriminator between TIA and infarction
because 33% of TIAs have signs of infarction on MRI.
View a TIA as analogous to unstable angina
The overall 90-day stroke risk after TIA is about 9.5%
Doppler US still performs well enough to be useful in helping to risk-stratify TIA patients in the ED.
Due to its relatively low specificity (84%),
confirm any positive Doppler US findings with magnetic resonance angiography or CT angiography.
其實急診建議做 Doppler US 檢查 carotid stenosis
After TIA, the use of aspirin to prevent future vascular events is historically well accepted.
Current practice includes dipyridamole plus aspirin (reasonable as a first choice), clopidogrel, and aspirin alone
CHANCE : The combination of clopidogrel and aspirin was superior to aspirin alone for reducing the risk of stroke
in the first 90 days without increasing the risk of hemorrhage !!
The risk of recurrent stroke in the presence of atrial fibrillation without anticoagulation is low,
probably < 5 % over the next 48 hours
Moreover, the risk of hemorrhagic transformation of an acute stroke is also greatest in the first 48 hours.
Consequently, in the setting of acute atrial fibrillation, anticoagulation therapy typically should not be started in the ED
but should be initiated in the inpatient setting.
因為 Af 短期再度中風的機率低, hemorrhagic transformation 風險更大
急診不考慮 anticoagulation therapy, 住院後再說 !
No net benefit of anticoagulants in acute stroke
The use of unfractionated heparin, LMWH, or heparinoids for emergent treatment of a specific stroke subtype or TIA
cannot be recommended based on available evidence, even in the presence of atrial fibrillation
不管哪種 CVA, TIA 或甚至有 Af, 都不建議急性期用 heparin, LMWH
This clinical policy recommends that current risk stratification instruments such as ABCD2
should not be used to identify TIA patients who can be safely discharged home.
不能用來決定病人是否出院回家
Specifically, “the ABCD2 does not sufficiently identify the short-term risk for stroke to use alone as a risk-stratification instrument.
單獨使用 ABCD2 不能辨認出 Low risk 病人
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