Current trends in treatment of transient ischemic attacks

Current trends in treatment of transient ischemic attacks (TIAs) are reviewed. Patients with TIAs should be treated individually, the main goals of therapy being to avoid cerebral infarction and vascular death. Management of risk factors includes control of high blood pressure, dyslipoproteinemias, diabetes mellitus, atrial fibrillation, cardiac arrhythmias, and overweight. A healthy diet, exercising and non-smoking are additional useful measures. The most commonly used antiplatelet drug is aspirin. Doses of 325 mg per day are as effective as doses of 1,300 mg per day but have fewer side effects. Ticlopidine seems the best antiplatelet drug currently available; it is given in doses of 500 mg per day for a month and then 250 mg per day for the rest of the patient's life. Anticoagulants have not shown their advantages over drugs that prevent platelet aggregation. However, when a patient under treatment with warfarin with an adequate dose range suffers recurrent TIAs, warfarin can be used in association with ticlopidine. On the other hand, if patients under treatment with ticlopidine have further TIAs, they should be switched to anticoagulants for 6 months and then back to antiplatelet drugs. With regard to surgery, an effective means of prolonging survival seems to be the treatment of coronary artery disease before carotid endarterectomy is considered. The effectiveness of carotid endarterectomy is being evaluated in ongoing multicentric, randomized, controlled clinical trials.