Supplement to the Guidelines for the Management of Transient Ischemic Attacks

In 1994, a panel of the American Heart Association Stroke Council published guidelines for the management of transient ischemic attacks (TIAs).1 Over the last 5 years, many significant advances in medical and surgical therapy for patients with TIAs have occurred. In addition, new data regarding risk factors for cerebral ischemic events have become available. These scientific advances have prompted this supplement to the 1994 guidelines, which provides updated recommendations for management of patients with TIAs.Specific stroke-prevention strategies after a TIA are tailored to the most likely cause of the event and the patient’s underlying risk factors as determined by a focused, expedient diagnostic evaluation. For more information about epidemiology, etiology, and diagnostic evaluation of TIAs, see the original guidelines.1 For the current report, panel members followed the rules of evidence used by the 1998 American College of Chest Physicians Conference on Antithrombotic Therapy.2 The approach to stroke prevention among patients who have already had their first TIA includes identification and modification of stroke risk factors. Nonmodifiable risk markers for stroke include age, sex, race-ethnicity, and heredity.3 Although these risk markers cannot be changed, they nonetheless serve as important identifiers of patients at risk of stroke, for whom an aggressive search for other modifiable risk factors might be particularly important. Modifiable stroke risk factors include hypertension, cardiac disease (particularly atrial fibrillation), diabetes, hypercholesterolemia, cigarette smoking, excessive use of alcohol, and physical inactivity. Numerous prospective studies and clinical trials have consistently shown a decreased risk of stroke with control of most of these conditions, although few of these studies were conducted in TIA cohorts.1 Reduction of both systolic and diastolic pressure in hypertensive subjects substantially reduces stroke risk.4 5 Reduction of isolated systolic hypertension to <140 mm Hg in the elderly, for example, in the …