This has been looked at extensively and in fact there is ongoing work at the moment.  Currently we would split it into treating the stickiness of the blood and looking at the vascular risk factors.  The stickiness of the blood would be medications like aspirin, although now we’re tending to use a medication called clopidogrel, which is very similar to aspirin but thought to be slightly better in the TIA context.  What we would generally do is give you a high level of medication in the first dose, which is what we call a loading dose. That would be around 300mg and is to boost the body’s levels of that medication. Then you would go on a regular daily dose of 75mg once a day.  At the same time, we will often give you a statin medication. There is a lot of press about statins and they are the most commonly prescribed drug in the UK. Given in the right context, they have had a significant impact on recurrent strokes so we would want to start you on that early on. 

It is not just a cholesterol lowering effect, we believe there is an additional effect on what we would call unstable plaques in the blood vessel. We are very keen on low blood pressure and some people will say that their blood pressure is higher when they see a doctor. You can buy a blood pressure monitor now to monitor your blood pressure at home and the target that you’re aiming for is less than 130 which is the top number, and less than 80 for the bottom number.  For some people that will be unachievable as they get dizzy when they stand but it is about getting the lowest blood pressure you can tolerate. In summary, it is clopidogrel or an anti-stickiness medication, a statin medication and an anti-hypertensive. For TIAs we know that those three combinations together reduces the risk of recurrent stroke in the order of 80%.