Treatment of Minor Noncardioembolic Acute Ischemic Stroke (NIHSS ≤3) or High-Risk TIA (ABCD2 ≥4) Without Thrombolysis
This protocol addresses the acute management of patients presenting within 24 hours of symptom onset with a minor ischemic stroke or a high-risk transient ischemic attack who have not received intravenous thrombolysis.
Clinical Scenario
Minor noncardioembolic acute ischemic stroke (NIHSS score ≤3) or high-risk transient ischemic attack (ABCD2 score ≥4), presenting within 24 hours of symptom onset, in patients who did not receive intravenous thrombolysis.
Treatment Approach (partial overview)
The first-line strategy centres on early dual antiplatelet therapy, initiated within 24 hours of symptom onset. The full protocol specifies which agents to use, how to sequence them, and for how long — including an alternative combination for select patients.
Complete regimen, agent selection, and clinical decision points available via the structured protocol below.
References
DOI: 10.1161/STR.0000000000000513
In patients with minor (NIHSS score ≤3) noncardioembolic AIS or high-risk TIA (ABCD2 score ≥4) who did not receive IVT, DAPT (aspirin and clopidogrel with loading dose of clopidogrel) should be initiated early (within 24 hours after symptom onset) and continued for 21 days, followed by single antiplatelet therapy (SAPT) to reduce the 90-day risk of recurrent ischemic stroke.
In patients with recent (<24 hours) minor (NIHSS score ≤5) noncardioembolic AIS or high-risk TIA (ABCD2 score ≥6 or symptomatic intracranial or extracranial ≥50% stenosis of an artery that could account for TIA) who did not receive IVT, DAPT with ticagrelor (including loading dose) plus aspirin for 30 days may be considered to reduce the risk of 30-day recurrent stroke.