Monitoring and advice for transient ischaemic attack (TIA)
Treatment for a TIA or minor stroke is aimed at preventing another one happening, and lowering the risk of stroke. After a TIA or minor stroke most people are prescribed drugs to reduce the risk of clots forming in their blood and blocking their carotid arteries or other blood vessels in the brain. They may also be prescribed medication for high blood pressure and/or high cholesterol (see ‘Medication, treatment and surgery for transient ischaemic attack (TIA)'. Many of the people we spoke to returned to visit their GP, consultant, or stroke clinic for ‘check- ups’ at different intervals after the event, depending on their needs and circumstances. This might typically involve blood pressure checks, blood tests and monitoring of medication. One man found his pharmacist useful and supportive and he said it saved him wasting his doctor’s time. Some of the people we interviewed were specifically invited for these follow up appointments, whereas others said they had not been invited for on-going appointments and just went to see the GP if they felt they needed to. Some felt they would have liked to be more closely monitored in the early days after their ‘episode’. Martyn (below) said that if he hadn’t had a TIA in the first place he wouldn’t have been monitored so closely, so in some ways he feels better off than he was before.
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Clare went to see her GP after her minor stroke and felt very well supported
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After having two small TIAs diagnosed Martyn regularly visited the GP to have his blood pressure and cholesterol levels checked and his medication was reviewed
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Roger sees the GP once a year for blood tests and monitoring but says he can talk to the local pharmacist if he has any worries or concerns
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Profile Info
- Age at interview:
- 50
- Sex:
- Female
- Age at diagnosis:
- 48
- Background:
- Clare is married and has three adult children. She works as a drugs counsellor. Ethnic background; White British.
I’ve been, both actually, I’ve been to my GP and outpatients. And my GPs have been absolutely fantastic, they really have.
I mean, obviously they’d had a letter from the hospital to say I’d had a stroke and when, when I went to see the GP he, he came out of his office to come and meet me because obviously he didn’t know how badly I’d been affected.
Oh that was good. So they …?
Yeah.
He call, did you call you in to actually have a chat with you and find out how things were? Or did you make an appointment?
I made an appointment to go and see him.
Right.
Yeah.
OK.
But he was very empathic. Very.
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Profile Info
- Age at interview:
- 64
- Sex:
- Male
- Age at diagnosis:
- 57
- Background:
- Martyn is married with two adult children. He is a retired head teacher. Ethnicity; White British.
I carried on with the medication. The medication changed slightly. Saw the GP once every three months maybe. The blood pressure was higher than it should have been, high, it was higher than was reasonable so she changed the blood pressure medication.
Oh, that’s right, I had a, the surgery gave me a blood pressure monitor for a week to do three readings a day, so I had 21 readings in the week and it was obviously high, it was about 100, average of I think 160 over 100 which was a little too high for comfort I guess on the long term, long term basis. So I was changed onto two blood pressure pills, like 2mg perindopril and 10mg of, of felodopine and I was taking, I started taking those, I’m still taking those. Been taking them since the last seven or eight years. And I’ve been taking the aspirin. I still take the aspirin. Oh that’s right, and I was prescribed a statin as well, and obviously I had blood tests, at the various times I had blood tests and as a, the result of that test they decided my, my cholesterol was higher than, it wasn’t too high, it was about five or six or something, but they wanted it a bit lower so I went onto 10mg of pravastatin and ever since then I’ve had an annual blood test and I see the doctor twice a year for blood pressure, once a year for the blood test and they check over the blood test results. So I’m monitored on that basis by the local surgery. My cholesterol is quite good. My the bad, the LP, whatever it is, the bad cholesterol is very low, and, I’m sorry, and the good one is higher so that is fine. The blood pressure is very well monitored and controlled and that’s quite acceptable. So no nasty episodes since.
I’m being monitored. Which I’ll, which would not have happened, which I guess would not have happened had the TIAs not happened.
So you’re getting an extra bit of MOT. [laughs] That’s …
It could be argued therefore the TIAs were, well I can’t say they were a good thing but in a sense, they in a sense they, it was a warning and since then the monitoring has been very good and, yeah, I’m very happy with the way I’m looked after.
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Profile Info
- Age at interview:
- 67
- Sex:
- Male
- Age at diagnosis:
- 64
- Background:
- Roger is married and has one adult child. He works part time as a musician. Ethnic background; White British.
just blood tests, perhaps every twelve months or something, but generally not anything else.
I’ve started to get the repeat prescriptions from the pharmacist, rather than go back and annoy the GP all the time.
Right, so does it feel quite more comfortable to talk to the pharmacist, more casual maybe?
Yes. Yes. It does in a way. Yes, and you don’t need an appointment obviously, and you can just walk in, and in fact some of them are thinking of taking on more medical jobs as such. So yes, I mean, he’s very useful.
Some pharmacies do actually have a little consulting room.
Yes, they do.
I don’t know whether you actually… or yours is a more casual type of conversation.
It is more casual yes. More casual. They do have one at but there is some…
So do you feel as though, if you’ve got an issue or a worry that you could go to the pharmacist?
Yes, yes, that’s right. You could, yes, that’s right. They will think about it and try and help you through. Yes. They’re useful pharmacists.
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John took part in a research study in which he had his blood pressure monitored and the results were sent on a daily basis down a phone line to the research team
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Angus checks his blood pressure at home regularly and then sees the research team every three months so that they can monitor how things are going
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Profile Info
- Age at interview:
- 59
- Sex:
- Male
- Age at diagnosis:
- 58
- Background:
- John is a documentary film-maker, married with one daughter. Ethnic background/nationality' White British.
The GP explained that she, her practice was part of a group of practices associated with a research programme at the university, and I would get instant access to hospital, which was tremendous. And after the initial consultation, at the end of the consultation it was explained to me by the consultant I met that there was a research programme taking place, “Would I be happy to take part in it?” And it was, the initial request was, “Would I take my blood pressure three times a day?” and this would be sent in by mobile phone. Very happy to do that. And it’s been something which has, which has proved extremely useful, because that blood pressure is monitored and I’ve had telephone calls from the hospital suggesting that I change medication, as a result of the observation they see taken from those readings. So delighted with that. And I’ve also been involved in a research project at the university looking at developing new MRI techniques.
So very happy with those. And you feel, especially with the monitoring, you feel actually somebody’s there [laughs]. So you don’t have to rely on your own understanding of what’s happening. Somebody’s actually seeing genuine data coming in on a daily basis.
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Profile Info
- Age at interview:
- 61
- Sex:
- Male
- Age at diagnosis:
- 60
- Background:
- Angus works as a fence erector for sports events. He is married with 3 adult children. Ethnic background/nationality' White British.
And what have they said to you now because we’re what three months later about what your level of risk is now?
It’s back to where it should be, it’s normal, albeit I’ve still got to take these tablets, and probably will have to for the rest of my life, to keep my blood pressure right down. Yeah,, so I’ve not been told to restrict myself in any way. In fact the hospital puts me on treadmills and makes me run marathons on them just to see how I react [laughs].
Were you surprised not to be kept in hospital?
Not really, no, no. They explained to me that - I mean, I went up the hospital in the next, in that first month I was up there twice a week, I should think, and in that time I had 24-hour monitors attached to myself, blood pressure monitors, ECG monitors and various monitors. And then went back up and had them removed from me. So they were keeping me sort of monitored 24 hours a day. I was doing my blood pressure three times a day, it was three times a day and three times each time, if you see what I mean, so it was like nine times. And that was being transmitted, I had a mobile phone from the hospital that they gave me and as soon as I took the blood pressure it sent the figures off to the hospital. So I was being monitored by the hospital all the time, you know, in this month, that was, that first month and I was doing this blood pressure three times. So there was, I was being monitored by the hospital sort of three times a day.
And in fact they rung me up a couple of times and told me to change my medicines – well, not change them, but up the dosage on particular ones.
Was that quite reassuring?
Well, it was, yeah, because you felt someone was on your, someone was there looking at you all the time, and I thought it was like being in hospital, actually. As good as, because I was being monitored basically 24 hours a day, you know. And yet I was at home with the family and it was great, you know.
I had a detailed MRI. I had, when we went up the first time we had a sort, if you like, a quick scan, but the second time I went up for another appointment to have a more detailed one which lasted quite a long time in the scanner, they found a few things in there, probably associated with my age, but nothing untoward, nothing what shouldn’t have been there. And the same with the rest of the system they scanned through, there was nothing untoward other than normal ageing, that’s how they put it, you know.
And this issue of causes and the fact that they can’t find anything particular…..?
No, he seems to think blood pressure’s got a big thing to do with it, because I have suffered with blood pressure for a number of years and I’ve been taking tablets for it. And I thought it was quite under control, because it was round about where it should be and had been, because they monitor me. I’ve always monitored my blood pressure . But apparently, probably damage had been done before I realised or maybe - they’re not sure, no one’s quite sure, really, what - and hence this study what they’re doing now. I’m still in this study the hospital’s running and will be for, well, a minimum of five years, whereas I monitor my own blood pressure and write it down, then every three months or so I get another hospital appointment, take it up there and discuss the blood pressures and see if there is anything on there to , if anything happens to me, to see if the blood pressure’s sort of gone that way to give them a pointer of what it is, you know. But they’re not even too sure, reall
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Profile Info
- Age at interview:
- 68
- Sex:
- Male
- Age at diagnosis:
- 68
- Background:
- Ken has been married for 50 years and cares for his wife who is disabled. He is a retired shop manager. Ethnic background; White British.
first of all you had a blood test. Then you go and see a, a nurse and she takes all the details and she tells you all about it. And you now once a week I’ve been going to the hospital to have a blood test to see whether my blood clots are high or low, whether the tablets are going to change. You have to write everything down in the book, in the piece of paper. You have to tell them the change of everything, you know, change the medication, whether you bruise badly after the injection and things like that. It’s just so you’ve got that for the rest of your life. And then she said, “All right, you can work up to one in three months.” But she said there’s not many people that get the three months. Eight weeks between one blood test to the next.
So how do you feel about the prospect of having to keep going through that all the time?
Not very happy about it, but if it means it’s going to keep me going, well, I’ve got to do it, you know. Don’t like it, but got to do it.
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Profile Info
- Age at interview:
- 58
- Sex:
- Male
- Age at diagnosis:
- 58
- Background:
- Keith is married with one adult son who lives at home. He is a primary school head teacher. Ethnicity; White British.
Are you having regular checkups now, what’s the position now?
Right, position now is, blood, blood is being tested once a week and I’m on a sort of warfarin balancing act at the moment. So I take certain warfarin tablets in different strengths of warfarin tablets and....
I’m on the warfarin trail at the moment, trying to balance out, my target apparently is 2.5 on the, the warfarin scale. I’m not quite sure what, what that’s called but so it means that my blood is tested once a week and I get instant feedback again from whoever analyses the, the blood and it, it is instant. It’s either the same evening or the following morning and, and adjustments are made to the strength of the warfarin that I take.
So how is all this accomplished? Do you go …
Right so I …
… in every day?
Yeah, I go into the GP once a week to the GP’s, you know, to my local practice and blood’s taken there, tested, and as I say, either that very same evening or the following morning I’m fed back by telephone and then later by post as to the adjusted warfarin strength. So at the moment I’m above the level I should be so probably to put it crudely again the blood’s too thin so they’ve reduced the strength of the tablets that I’m taking.
Have you had to have many alterations to this …
Every week, yeah. It’s gone up and down and, and changed a little bit very gradual, very minor changes, bit by bit and over the, say 10 weeks, no eight weeks that, since the stroke it, it’s gradually coming into place you know, and it’s gradually getting closer to that 2.5 level.
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Ros hasn't been called in for regular monitoring but goes to see the GP if she feels she needs to.
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David was prescribed blood pressure tablets and aspirin but since then has not been called back to be monitored
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Gillian has a blood test and her blood pressure checked now and again when the district nurse comes to visit
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Ken would like to be monitored more regularly so that he can be sure things are okay
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Profile Info
- Age at interview:
- 69
- Sex:
- Female
- Age at diagnosis:
- 69
- Background:
- Ros is divorced and currently lives alone. She has two adult children and two grandchildren. She is a retired keep fit teacher. Ethnic background' White British.
I’ve had a blood test and it’s all right. My cholesterol is low. I had to phone up for the details and that’s it, they’ve, you know, I don’t have to go to the doctor unless I need a doc, the doctor.
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Profile Info
- Age at interview:
- 67
- Sex:
- Male
- Age at diagnosis:
- 67
- Background:
- David is married and lives with his wife Shirley. They have four adult children. He is a retired mini bus driver. Ethnic background; White British.
What was the advice? Did you give, get given medication? What happened?
They gave me some, they gave me different... blood pressure tablets, but that was about all really. And I think I didn’t, didn’t get any medical advice as such.
Were you told to take aspirin?
Oh yes, yes of course I was, sorry yes. I got a higher dose of aspirin for the first fourteen days and then I’d gone down onto a higher than normal but slightly lower dose than that now. Yes.
And do you understand what the reason for that is?
Well it keeps the blood thin doesn’t it? Yeah.
And so, I mean I know that you said that you hadn’t really given a kind of proper explanation of the TIA, so would you be able to understand why you need your blood thinned to avoid any further problems or is that something you haven’t really had explained to you?
I haven’t really I don’t think.
Right.
Although from my own knowledge of first aid and that obviously if it’s thinner, it’s easier for the heart to get it through and it stops the heart working so hard and hopefully it won’t get across again.
And so were you also told about you know the likelihood or possibility of, of anything further happening or were you just left to your own devices on that score?
Well apart from the fact of being told that I couldn’t drive for a month. I was virtually left on my own. I wasn’t told, I mean well I read in a leaflet actually that it is possible to have one although it’s you know obviously far from definite or anything else. In fact it’s probably more unlikely now because I’ve been on medication hopefully that will stop any symptoms happening.
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Profile Info
- Age at interview:
- 92
- Sex:
- Male
- Age at diagnosis:
- 90
- Background:
- Gillian is widowed and has a live in carer to help her with day to day activities. Ethnic background; White British.
Are you still being monitored at all? You know, does the doctor come and check you over …
Well…
… at all? Or …
...the only thing is they sometimes they send District Nurse for some blood. Or blood pressure. But that’s about all.
You take medication for that is it still quite high then or does it ever go down a bit? Your blood pressure?
Oh yes, it, I think it does go down, yes. Sometimes the District Nurse turns up and takes the blood pressure and after she says, “Oh, it’s not too bad today”.
Right. So it’s variable?
So, yes it, it does vary a bit. I think it’s not too bad at the moment.
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Profile Info
- Age at interview:
- 68
- Sex:
- Male
- Age at diagnosis:
- 68
- Background:
- Ken has been married for 50 years and cares for his wife who is disabled. He is a retired shop manager. Ethnic background; White British.
I’d like to see more follow ups after you’ve....
...had the initial check. Because, as I say, I’ve had nothing from this from then to now and just to be reassured, you know. I don’t know how quickly things can, well, what I had, came off very quickly and went very quickly but [sighs] I don’t’ know if you, these scans can show more or not, I don’t know, if you had a check up every so often, especially when people have had these sort of problems.
So is there a slight feeling that you’ve been left now that it’s all happened …
Yeah.
.. and you’ve got medicated …
Yeah, yeah. That’s the thing.
And you’d rather have being monitored a little bit more closely?
Yeah.
For now?
Well, from, say for the first year, six months or a year, you know, so see whether there’s a problem there and be in, you know, be dealt with.
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Profile Info
- Age at interview:
- 68
- Sex:
- Male
- Age at diagnosis:
- 65
- Background:
- Geoff is married and has three adult children. He is a retired bank employee. Ethnic Background; White British.
Enid' Well, the other week, a few weeks ago you said you were going dizzy when you bent down. And it was me that spotted it because I, and I said, “Are you dizzy?” He said, “Yes.” I said, “Right, the doctor’s.” So the doctor looked at his prescriptions and he said, “Well, I will take you off this straight away and put you on another one.” And he said, “I’ve been on that since I had my heart by-pass.” He said, “Yes, you probably have.” He said, “Because then in 2001 that was the gold star.” He said, “Now what I’m going to put you on now is the gold star.”
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Profile Info
- Age at interview:
- 28
- Sex:
- Female
- Age at diagnosis:
- 26
- Background:
- Michelle is single and lives with her parents. She is currently not working due to ill health. Ethnic background; White British.
Are you monitored, do you have to go for appointments and things still?
I have six monthly blood checks but that’s it. OK.
I was in the hospital for three weeks and I would say at least three, possibly four weeks whilst I was still at home recovering, and in between them I would get different feelings and slowly it came back in my leg.
When you were at home recovering, what did that consist of? Did you, were you given things to, that you had to do like physio and stuff, that you carried on …
Yeah…
… doing?
I had physio that came, I think it was twice a week.
Somebody came to the house?
Yeah.
Right.
And occupational therapy, they came.
What was that like? Doing the physio and the occupational therapy?
Doing the exercises that they gave me, I couldn’t really see the point of what they was trying to do. I did them but I can’t see how doing the exercises that they did made it any better or any worse. Because even if I didn’t do them things were still happening and so …
Right. So was the same kind of communication issue with the physio and the occupational health people, were they not as good at explaining things as perhaps they could be?
Not really, no.
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Rich takes medication and says he has his 'MOT' once every 12 months, but that there are no resources for more to be done to help with mobility or other problems
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Mike goes to see his GP regularly for blood tests, as he also has another condition that needs monitoring, but he has to remember to go to get his blood pressure to be taken
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Profile Info
- Age at interview:
- 66
- Sex:
- Male
- Age at diagnosis:
- 62
- Background:
- Rich is married and has two adult children aged 31 and 27. He retired from his career in sales and marketing after his mini stroke. Ethnic background' White British.
One of the things I remember being, I forget who told me now, one of the things I remember was [hammering] someone saying that TIAs a warning. If you recover from that, you’ll be OK. But you could have another stroke. I remember that particular point. And yeah, TIA, yeah. It’s a warning.
But you haven’t had anybody talk to you any more about that?
No.
No.
No. No. No. No.
But you are being monitored, you said, by your GP?
Once every 12 months. Once every January I go in for my MOT, for want of a word, and that’s …
It’s interesting that there hasn’t been a discussion about that really, between you and your GP? In terms of …
Yeah.
.. thinking about, you know, because you were, you’ve been talking about preventative measures really. And it, you know, if there is some kind of idea that it could be a warning?
Well, I was going to say, that, this is, I don’t know whether it’s because, you know, I’m maybe thinking about it a bit more but going back to going back to what I was saying to you what came out in this the Voices magazine, which comes from the Stroke, about ‘moving on’ campaign, there seems to be a point in time where, where your let’s say, we’ve finished with you, we can’t do any more, but they could do, because the resources aren’t there. Now I don’t know whether what you’re talking about me in particular talking to the doctors whether or not they see it as a problem, because there’s no resource that they can actually put you to.
Right.
You know.
But you haven’t been given any advice about how to prevent anything further happening? It’s only …?
The only thing the only preventative measures that are, I was talked to about, and funnily enough I had to ask, about a week or so before I was, I came out of [ward name], I said “What about food? Dietician?” “Oh do you want to see one?” And basically a dietician was brought. It wasn’t part of the, let’s say the checklist, he’s done this, done that ….
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Profile Info
- Age at interview:
- 63
- Sex:
- Male
- Age at diagnosis:
- 53
- Background:
- Mike and Debbie married 10 years ago. He is a retired accountant and publisher. Ethnic background; White British.
Mike' I do think about it and well, whenever I can, which perhaps is not as often as it should be but I would, would, whenever I go to the GP, she always takes my blood pressure... whenever. And I should perhaps do more often than I do now, but I do, I do try, and try and go, go, go down say once every three months, three or four months and have my blood pressure checked. And it’s been, it’s been like...okay, disrupts you a little bit but currently it’s quite, quite good, quite good.
Debbie' You have six monthly blood tests as well, don’t you?
Mike' About six monthly blood tests, yes, that’s right.
So you’re still being monitored?
Mike' Oh yes, yes, yes, yes.
Debbie' Yeah.
Mike' Yes.
Debbie' And I think you, I think he always will be and, and as for the bladder he’s going to be monitored because it’s a, apparently it is a cancer that can return. So he’s always having somebody sticking needles or tubes or something into you, aren’t you? [Laughs].
Frequent MOTs?
Mike' Frequent …
Debbie' Frequent MOTs.
Mike' Frequent MOTs.
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Profile Info
- Age at interview:
- 63
- Sex:
- Male
- Age at diagnosis:
- 53
- Background:
- Mike and Debbie married 10 years ago. He is a retired accountant and publisher. Ethnic background; White British.
Debbie' And so I would say definitely have an annual, you know, have an annual, annual check up. You know, just go and ask, ask them just to do the run of the mill screen and check your blood pressure.
Mike' Hm. Hm.
Debbie' Because if he’d had it checked more often, you know, who knows. I mean, you can’t say it, it could have happened, it could have happened even with you taking pills but on the other hand as it was blood pressure related then probably it wouldn’t have done. You know. But you can’t, you can’t stop everything happening to you
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Profile Info
- Age at interview:
- 69
- Sex:
- Female
- Age at diagnosis:
- 69
- Background:
- Ros is divorced and currently lives alone. She has two adult children and two grandchildren. She is a retired keep fit teacher. Ethnic background' White British.
I changed my whole, whole life, I haven’t got a car any more. So I know if I haven’t got a car, then I have to walk. So, you know, I’ve, I’ve really tried to help myself.
And do you, have you found that you’ve got the impression that they haven’t kind of bought into that so much, or …
I don’t know. I don’t know really. Maybe I needed a bit more praise and saying, “Well, you’ve done well, you’ve, you know, you’ve, you’ve really done well.”
Encouragement?
But no, nobody’s said that, they’ve just …
No.
...left me to get on with it. I, that’s how I feel.
Yeah. I can see. So, you’re feeling a bit like, what you said earlier, not listened to and I suppose in a lot, for a lot of people encouragement is one of those ways …
Yes.
...isn’t it, that we keep going, …
Yes.
...and move forward.
It seems all negative, you know. I’ve, I feel that I’ve done well but nobody said, “Oh well done” you know, “You’ve really done well, you’ve lost four stone”.
You have.
“You’re walking where you never walked before”. I got rid of my car so that I, I make myself walk, I have to walk.
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Profile Info
- Age at interview:
- 54
- Sex:
- Female
- Age at diagnosis:
- 54
- Background:
- Yvonne is married and has an adult daughter and 2 young grandchildren. She is a police officer. Ethnic background' White British
It’s really scary actually. As I say, I’ve always been sort of super fit. I’ve got my own gym at home, you know. Was always going in there four or five times a week. Haven’t been able to touch it. I used to go swimming three or four times a week. And that’s all gone now. You know, I’ve, I’m scared to exercise I guess, unless there’s somebody else there.
I actually went into rehab, rehabilitation centre and I could exercise because I knew there were medics on hand so that if anything happened, you know, and, and people were watching me all the time and would come up to me and say, “I think you’ve done enough now.” “Step off.”
So it’s a bit reassuring to have somebody else …
Absolutely.
… overseeing what you’re doing. And that, how, how did you get to go to that rehab centre then? I mean, …
I’m a police officer and it’s, it’s a police charity so …
Oh, right. So, I mean, were you offered any, anything from, in, along those lines by your doctors?
No.
No.
No, nothing at all. I mean, basically I went to see the TIA nurse and she just said, “You, you need to lose a little bit of weight.” And I smoke an odd cigarette and she said, “You need to knock that on the head. And I'm, I’ll phone you in a couple of months.” And I actually haven’t had that phone call so …
Last reviewed June 2017.
Last updated June 2017.
