Manejo do paciente com AIT prévio

Management

The following should be done urgently in patients with TIA:

• Evaluation
  Risk stratification (eg, with the California or ABCD score )
  Initiation of stroke prevention therapy

For patients with a recent (within 1 week) TIA, guidelines recommend a timely hospital referral with hospitalization for the following:

• Crescendo TIAs
  Duration of symptoms longer than 1 hour
  Symptomatic internal carotid stenosis greater than 50%
  Known cardiac source of embolus such as atrial fibrillation
  Known hypercoagulable state
  Appropriate combination of the California score or ABCD score (category 4).

Antithrombotic therapy should be initiated as soon as intracranial hemorrhage has been ruled out, given the high short-term risk of stroke following TIA. For noncardioembolic TIA, the following antiplatelet agents are all reasonable first-line options for initial therapy:

• Aspirin (50-325 mg/day)
  Aspirin plus extended-release dipyridamole
  Clopidogrel

Stroke prevention medication typically recommended for cardioembolic TIA is as follows:

• For patients with atrial fibrillation after TIA, long-term anticoagulation with warfarin (goal INR, 2-3); aspirin, 325 mg/day, for those unable to take oral anticoagulants
  In acute MI with left ventricular thrombus, oral anticoagulation with warfarin (goal INR 2-3; concurrent aspirin, up to 162 mg/day, for ischemic coronary artery disease
  In dilated cardiomyopathy, oral anticoagulation with warfarin (goal INR 2-3) or antiplatelet therapy
  In rheumatic mitral valve disease, oral anticoagulation with warfarin (goal INR 2-3)

For patients with TIA due to 50-99% stenosis of a major intracranial artery, the following is recommended:

• Aspirin at 50-325 mg/day, rather than warfarin
  Maintenance of blood pressure below 140/90 mm Hg and total cholesterol below 200 mg/dL
  Angioplasty or stent placement is investigational and of unknown utility

Referência: Transient Ischemic Attack - http://emedicine.medscape.com/article/1910519-overview