Transient Ischemic Attack Medication

Updated: Sep 11, 2017
  • Author: Ashish Nanda, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Medication

Medication Summary

Pharmacologic management for transient ischemic attacks (TIAs) is aimed at reducing both short-term and long-term risk of stroke. In view of the high short-term risk of stroke after TIA, antithrombotic therapy should be initiated as soon as intracranial hemorrhage has been ruled out.

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Antiplatelet Agents

Class Summary

Antiplatelet agents inhibit platelet function by blocking cyclooxygenase and subsequent aggregation.

Aspirin (Anacin, Ascriptin, Ecotrin, Bufferin, Bayer Aspirin)

Aspirin blocks prostaglandin synthetase action, and this, in turn, inhibits prostaglandin synthesis and prevents formation of platelet-aggregating thromboxane A2.

Aspirin 25 mg/dipyridamole 200 mg (Aggrenox)

Combination aspirin-dipyridamole therapy has been shown to prevent cardiovascular events following TIAs. Each capsule contains 25 mg of aspirin and 200 mg of dipyridamole, for a daily total dose of 50 mg of aspirin and 400 mg of dipyridamole.

Aspirin irreversibly inhibits formation of cyclooxygenase, thus preventing formation of thromboxane A2, a platelet aggregator and vasoconstrictor. Platelet inhibition lasts for the life of a cell (approximately 10 days).

Dipyridamole is a platelet adhesion inhibitor that possibly inhibits red blood cell (RBC) uptake of adenosine, itself an inhibitor of platelet reactivity. In addition, it may inhibit phosphodiesterase activity, leading to increased cyclic 3′,5′-adenosine monophosphate within platelets and formation of the potent platelet activator thromboxane A2.

Clopidogrel (Plavix)

Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.

Dipyridamole (Persantine)

Dipyridamole is administered to complement usual warfarin therapy. It inhibits platelet adhesion, which may inhibit adenosine uptake by RBCs. It may increase cyclic 3′,5′-adenosine monophosphate (cAMP) within platelets and formation of the potent platelet activator thromboxane A2. In addition, it may reduce the risk of stroke when used as monotherapy instead of aspirin.

Ticlopidine (Ticlid)

Ticlopidine is a second-line antiplatelet therapy for patients who cannot tolerate or do not respond to aspirin therapy. In some circumstances, it can be an alternative to clopidogrel.

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Anticoagulants

Class Summary

Controlled therapeutic inhibition of blood clotting by means of appropriate drugs (ie, anticoagulants) is indicated for prevention of ischemic stroke in patients with risk factors for thromboembolism, such as atrial fibrillation.

Warfarin (Coumadin)

Warfarin interferes with hepatic synthesis of vitamin K−dependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders.

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