The treatment of choice for recurrent transient ischemic attacks in a patient on aspirin with new-onset atrial fibrillation:
b) Carotid endarterectomy
d) Corticosteroid treatment
e) Carotid stent
The correct answer is A.
Patient compliance with antiplatelet therapy should be determined. When possible, the cause of the TIA or sroke should be identified. If there is evidence of new-onset atrial fibrillation or a cardioembolic source, anticoagulation (rather than antiplatelet therapy) may be required, depending on the patient’s age and other risk factors.
Anticoagulation is indicated in patients with any one of prosthetic heart valve, prior history of rheumatic heart valve disease, prior history of stroke or transient ischaemic attack, age older than 75 years, hypertension or coronary artery disease with poor left ventricle (LV) function.
Carotid endarterectomy is indicated where there is symptomatic carotid stenosis.
Clopidogrel would be indicated in TIA without atrial fibrillation.
Corticosteroids may be considered in cases of cerebral oedema where there is significant mass effect.