Think FAST: Aspirin +/- Clopidogrel?

Remember FAST?  That's the acronym for stroke symptoms: Face, Arm, Speech & Time.  In other words, if your face doesn't look right (it's droopy), your arms (or legs) are weak/clumsy, and/or your speech is slurred, you don't have much time to call 911 & get to a stroke center for emergent imaging & potential treatment, eg clot busting drugs.  Bit of advice: don't drive yourself to the hospital, you might get worse & lose control of your vehicle.  So get someone else to drive you there.

So what's a TIA?  Transient ischemic attack.  It's a small or minor or mini-stroke in which you regain your function in less than a few hours and return to baseline w/o any function loss or impairment.  The problem with the TIA is that it's a warning shot across the bow.  It's the canary in the mine.  In a not so small percentage of patients who've suffered a TIA, they go on to sustain a massive stroke in the next few days to weeks, up to a third in a year, w/complete permanent loss of function.

So how do you prevent this from happening?  Well, if the symptoms were witnessed & definitely stroke-like, and occurred during the day and you can get in contact with your family physician, sometimes s/he can push through a rapid evaluation (brain scan, carotid ultrasound, electrocardiogram, echocardiogram) & aggressively treat your risk factors, eg high blood pressure, high cholesterol & high sugars.  However, these tests may take several days if not weeks to obtain as an outpatient if your insurance is particularly meddlesome.  That's why the evaluation of a suspected TIA is often best expedited in the ER where everything can be done before you're sent home.

But then what?  Your evaluation is negative but you still had that event.  What's your next step?  In the past, we've discussed the option of aspirin vs warfarin.  However, in a randomized placebo controlled study published early online in the New England Journal of Medicine, the authors concluded that aspirin + clopidogrel prevented more ischemic strokes than aspirin alone.  Better yet, there was no increase risk of hemorrhagic strokes.  To arrive at their conclusion, the authors randomized 5,170 participants avg 62yo to either aspirin alone or aspirin + clopidogrel.  Within the 1st 90 days of treatment, offering clopidogrel to 29 participants would prevent one stroke.

God forbid you're (un)lucky enough to have a TIA.  Ask your doc about using dual anti-platelet agents to prevent a stroke.

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