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Chapter 4

TIA Evaluation and Disposition

Cam Berg, MD and Rob Orman, MD
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24:37
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Rob and Cam Berg discuss TIA Evaluation and Disposition.

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Joel R. -

So, what about the CHANCE study with regards to TIA? Seems like the 21 days clopidogrel might be the sweet spot.

Rob O., MD -

Hey Joel!

Thanks for bringing this up. I agree, CHANCE shows a signal of benefit with clopidogrel plus aspirin versus aspirin alone in patients with transient ischemic attack or minor ischemic stroke. I don't think doing this is wrong by any stretch and provides good evidence for adopting a strategy of what you're saying.

A few challenges I have with the CHANCE trial are that it was carried out in China, so then there’s the question that always comes up with these massive Chinese stroke trials, do the results then apply to those who are not of Chinese ancestry? Another challenge is that there were equal bleeding rates between the aspirin and aspirin + clopidogrel groups. That's not always the case when these different treatment pathways have been studied.

Curious if you have adopted aspirin + clopidogrel for 21 days and/or that is the direction your neurologists have taken.

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