🧠 Ischemic Stroke / TIA Secondary Prevention
UseDirection for secondary prevention after ischemic stroke or TIA.
SourceChinese Guideline for Secondary Prevention of Ischemic Stroke and TIA 2022
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Adults with suspected acute stroke when quantifying deficit and deciding reperfusion, or TIA when judging short-term risk.
- Who it is not for
- Do not use ABCD² to decide thrombolysis. No new stroke scale.
- Formula and variables
- NIHSS is the neurologic deficit; items stay as on this page. FAST-ED is a prehospital large-vessel screen. ABCD² is age, blood pressure, clinical features, duration, and diabetes, for TIA.
- Result → next step
- This scene links only to the three tools below: deficit and time window open the thrombolysis page. A positive large-vessel screen opens thrombectomy. Drugs after the acute phase open secondary prevention. Thrombolysis shows no number until weight, onset time, pregnancy, and recent anticoagulation are known. Anticoagulant-related intracranial bleeding goes to reversal and ICH management.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.IV thrombolysis →Thrombectomy →
- Guideline
- China acute ischemic stroke guideline 2023
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Methodology · worked example, guidelines & full notes
Short-term dual antiplatelet (21 days) benefits minor stroke / high-risk TIA; longer dual suits symptomatic intracranial large-artery stenosis, then de-escalate to single agent.
When to use
Direction for secondary prevention after ischemic stroke or TIA.
How it works
Non-cardioembolic → antiplatelet (single agent usually; clopidogrel + aspirin for 21 days after minor stroke or high-risk TIA; dual then single for symptomatic intracranial stenosis 70–99%). Cardioembolic (AF) → anticoagulation (NOAC preferred). LDL lowering to the current guideline target with large-artery atherosclerosis; BP if tolerated [pending update] with intracranial stenosis).
Key points
- Short-term dual antiplatelet (21 days) benefits minor stroke / high-risk TIA; longer dual suits symptomatic intracranial large-artery stenosis, then de-escalate to single agent.
- CYP2C19 loss-of-function carriers may use ticagrelor + aspirin in place of clopidogrel-based dual therapy.
- High-intensity statin with (add ezetimibe, then PCSK9i, if not at goal) for large-artery atherosclerosis.
- Assess CEA/CAS for symptomatic carotid stenosis 70–99%; control glucose, stop smoking, exercise.
References
- [Guideline / primary source]Chinese Guideline for Secondary Prevention of Ischemic Stroke and TIA 2022
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Stroke mechanism | Non-cardioembolic (atherosclerotic/small-vessel/undetermined) |
|---|---|
| Minor stroke or high-risk TIA within 24h | Yes |
| Symptomatic severe intracranial large-artery stenosis (70–99%) | Yes |
| Concomitant intra-/extracranial large-artery atherosclerosis | Yes |
→Antithrombotic regimenClopidogrel + aspirin dual antiplatelet for 21 days then switch to single agent (CYP2C19 loss-of-function carriers may use ticagrelor + aspirin for 21 days then ticagrelor monotherapy)
- Statin/LDL target：High-intensity statin, lower LDL-C to the current guideline target; add ezetimibe if not at goal (PCSK9i if needed)
- Blood-pressure target：Due to intracranial large-artery stenosis: [pending update]
- Other：Glycemic control (a GLP-1RA/SGLT2i with cardio-cerebrovascular benefit may be chosen in diabetes), smoking/alcohol cessation, exercise and weight control; assess CEA or CAS for symptomatic carotid stenosis 70–99%
| Stroke mechanism | Cardioembolic (AF, etc.) |
|---|---|
| Minor stroke or high-risk TIA within 24h | No |
| Symptomatic severe intracranial large-artery stenosis (70–99%) | No |
| Concomitant intra-/extracranial large-artery atherosclerosis | No |
→Antithrombotic regimenOral anticoagulation (NOAC preferred for AF and other cardioembolic causes; warfarin for mechanical valve or moderate-severe mitral stenosis)
- Statin/LDL target：If non-cardioembolic and LDL-C ≥ 2.6 give high-intensity statin; with large-artery atherosclerosis the target is < 1.8
- Blood-pressure target：Lower [pending update] if tolerated
- Other：Glycemic control (a GLP-1RA/SGLT2i with cardio-cerebrovascular benefit may be chosen in diabetes), smoking/alcohol cessation, exercise and weight control; assess CEA or CAS for symptomatic carotid stenosis 70–99%
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Ischemic Stroke / TIA Secondary Prevention?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Ischemic Stroke / TIA Secondary Prevention upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.