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Table 6 Case scenario 3b

From: Transient Ischaemic Attack (TIA) Knowledge in General Practice: a cross-sectional study of Western Adelaide general practitioners

With regards to treatment the following statements are true or false.
  True False Unsure Evidence
n n n   
1.Aspirin or aspirin/dipyridamole should be started 29 1 1 Studies have demonstrated that antiplatelet treatment significantly reduces the risk of stroke [26], with the combination of aspirin and dipyridamole shown to be more effective than aspirin alone [27].
2.Clopidogrel is 1st line 5 22 4 Trials continue to assess the benefits of clopidogrel in stroke prevention with some studies suggesting that it is more effective than aspirin alone. However, the MATCH trial compared Clopidogrel and clopidogrel with aspirin and found no significant difference [28]. The NSF suggests that clopidogrel should be considered for those intolerant of aspirin or if aspirin is contraindicated [23].
3.Referral for carotid endarterectomy(CEA) if duplex reveal ipsilateral carotid stenosis of 70-99 % 22 2 7 Carotid endarterectomy has been found to reduce the risk of disabling stroke or death for patients with stenosis exceeding ECST-measured 70 % or NASCET-measured 50 %, in surgically-fit patients operated on by surgeons with low complication rates (less than 6 %) [29].
4.ECG reveals AF and warfarin should be started 31 0 1 A Cochrane review in 2004 concluded that anticoagulation can reduce the risk of stroke in patients with non- rheumatic atrial fibrillation (AF) [30]
5.A lipid lowering agent (statin) should be started only if her blood test reveal hypercholesterolaemia 9 20 3 Whilst earlier trials suggested increased rates of intracerebral haemorrhage and concerns were raised about liver toxicity, recent studies have demonstrated a modest decrease in stroke risk with statin therapy [31].
6.Anti-hypertensive should be commenced regardless of BP 15 12 5 Evidence suggests that patients should receive BP lowering treatment after a TIA unless contraindicated by symptomatic hypotension [32].