How to avoid a stroke after a TIA

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Many people who have had a TIA are eligible for medications that reduce the chance of having another TIA or stroke. These include antithrombotic drugs.

There are two types of antithrombotic drugs: anticoagulant drugs, which slow down clotting, and antiplatelet drugs, which prevent clots from forming.

For stroke prevention, doctors usually recommend short-term antiplatelet therapy.

Doctors may also prescribe medications that lower blood pressure and cholesterol or prevent clots. These can include:

• aspirin
• statins
• antihypertensives

It is important to take the medications a doctor prescribes. A person may be able to bring their risk of stroke down considerably with other methods, but these will take time to work. Preventative drugs can bring the risk down more quickly and more effectively than lifestyle changes alone.

If a person smokes tobacco, they should aim to reduce or stop as soon as they can following a TIA.

People who continue smoking have a two-fold higher risk of stroke than people who do not. Secondhand smoke can also raise the risk.

To help a person quit smoking, a doctor can provide advice and drug therapy to help with nicotine cravings. This may include the use of nicotine patches, gum, lozenges, nasal spray, or inhalers. It can also include drugs that do not contain nicotine, such as bupropion.

Bupropion works by altering a person’s brain chemistry. It can help with smoking cessation, but it may also have side effects and is not suitable for everyone.

Heavy alcohol consumption also has links with ischemic stroke, particularly if a person has other risk factors. According to the United Kingdom’s Stroke Association, drinking a lot of alcohol can:

• raise blood pressure
• trigger atrial fibrillation, which is a risk factor for stroke
• damage the liver, which affects blood clotting
• make it harder to maintain a moderate weight, as many alcoholic drinks are high in calories

High alcohol use is equivalent to more than 4 drinks per day for males, or more than 3 drinks per day for females. If a person consumes this amount or more, they should try to reduce their intake.

People who are taking medications after a TIA should speak with a doctor about whether drinking alcohol is safe.

Find apps that may help a person stop drinking alcohol here.

Diet and nutrition play an important role in stroke prevention as they can influence many aspects of health. Diet can help a person:

• maintain a moderate weight
• avoid diabetes, which increases the risk of stroke
• maintain or lower cholesterol levels
• regulate blood pressure

There are several diet types that may help reduce the risk of stroke. One of the most well-researched is the Mediterranean diet, which can reduce the risk of stroke by around 40% or more in people at high risk, according to a 2019 article.

The Mediterranean diet involves eating:

• plenty of vegetables and legumes
• whole grains
• fresh fruit
• olive oil and other healthy fats

People should also limit their salt intake to 2–3 grams per day.

Learn more about the Mediterranean diet and how to build a meal plan here.

Physical inactivity has links with an increased chance of stroke. Similarly to a healthy diet, getting regular exercise has multiple benefits for reducing the risk, including:

• lowering blood pressure
• reducing cholesterol
• maintaining a moderate weight

The Centers for Disease Control and Prevention (CDC) recommend that adults get 2 hours and 30 minutes of moderate-intensity aerobic exercise per week. This can include:

• brisk walking
• running
• swimming
• water aerobics
• dancing

For people who have difficulty getting physically active due to other health conditions or a disability, there may be ways to adapt these activities. They should speak with a doctor, trainer, or physical therapist about the best ways to exercise.

In addition to taking steps to lower the risk of stroke, people can also reduce the risk of other conditions that may contribute to it. Alternatively, if they already have some of these conditions, they may need medical treatment to manage them.

Conditions that can elevate the risk of stroke include:

• obesity
• diabetes
• high cholesterol
• high blood pressure
• obstructive sleep apnea (OSA)

Many of these conditions can also benefit from the diet and lifestyle changes that help prevent stroke. In some cases, though, people may need specific dietary or medical interventions.

For example, a person with type 2 diabetes may benefit from a low glycemic index diet, while a person with OSA may need to use a device to keep the airways open at night.

Making big changes to a diet, daily routine, and lifestyle can feel overwhelming, especially if a person tries to make many changes at once. It may help a person to do the following:

• Get support: If a person’s doctor has not provided a comprehensive plan for reducing stroke risk, they can ask them for advice on diet, exercise, and smoking cessation, if relevant. In some cases, a person may need help from a multidisciplinary team.
• Tell loved ones: Telling friends and family about plans to reduce the risk of stroke may help someone stay accountable. It can also help if other members of the household join in with efforts to eat balanced meals and get active.
• Make gradual changes: Although it is beneficial to reduce the risk of stroke as soon as possible after a TIA, there are some things a person may not be able to do immediately. For example, a person who does not typically exercise will need to start doing this gradually in order to build up their endurance.
• Focus on enjoyment: With diet and exercise, it may help to focus on foods and activities a person already enjoys. This can provide motivation to stick with them.

Many of the risk factors for a stroke after TIA are things a person can control. With preventative medications, dietary changes, exercise, and management of coexisting conditions, people may be able to significantly reduce their risk of having a full stroke.

Making a lot of changes to a person’s daily routines can be challenging. If a person is struggling, they should consult their doctor, particularly if they are having difficulty stopping smoking or reducing alcohol intake.