At-a-glance (primary care)
- Suspected stroke: treat as an emergency and arrange immediate transfer to acute stroke services (999).
- Suspected TIA: offer aspirin 300 mg daily immediately (unless contraindicated) and refer urgently for specialist assessment (typically within 24 hours).
- Do not use ABCD2 (or similar risk scores) to “rule in/out” or delay referral — focus on rapid specialist assessment.
- Think mimics (migraine aura, seizure, hypoglycaemia), but do not let diagnostic uncertainty delay urgent referral if TIA/stroke is plausible.
Immediate actions (what to do now)
- Safety first: airway/breathing/circulation, glucose, temperature; check anticoagulants/antiplatelets and bleeding risk factors.
- Stroke red flags requiring emergency response: ongoing focal deficit, reduced consciousness, severe headache with neurological deficit, posterior circulation symptoms (ataxia, diplopia, dysarthria), seizures at onset, or any rapidly evolving neurology.
- Suspected TIA:
- Aspirin 300 mg daily immediately unless contraindicated (e.g., true aspirin allergy, active bleeding).
- Urgent referral to a TIA clinic/stroke specialist service (do not delay for outpatient tests).
- Document last known well and full symptom timeline (onset, duration, resolution).
Secondary prevention checklist (after specialist diagnosis)
- Antiplatelet/anticoagulation: follow specialist plan (e.g., antiplatelet for non-cardioembolic TIA/stroke; anticoagulation if AF or other cardioembolic source).
- Statin: high-intensity statin is common post-TIA/stroke (align with local stroke pathway and lipid guidance).
- BP: optimise BP to guideline targets (avoid undertreatment; check home readings if white-coat suspected).
- Carotid disease: symptomatic carotid stenosis may need rapid imaging and surgical opinion — document lateralising symptoms clearly.
- Lifestyle: smoking cessation, alcohol moderation, Mediterranean-style diet, exercise; address sleep apnoea if suspected.
- Driving / safety: advise per DVLA guidance (local policy), plus workplace safety if high-risk occupation.
Frequently asked questions
Should I give aspirin for suspected TIA in primary care?
Yes — NICE NG128 recommends offering aspirin 300 mg daily immediately for suspected TIA unless contraindicated, alongside urgent referral for specialist assessment.
Should I use ABCD2 to decide referral urgency?
No — NICE guidance advises against using ABCD2 (or similar scores) to delay or triage referral. Aim for rapid specialist assessment when TIA is suspected.
What should I include in the referral?
Exact onset/offset times (last known well), symptom description and laterality, current neuro findings, meds (especially anticoagulants/antiplatelets), vascular risk factors, and any relevant bleeding risk/allergy history.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.