ABCD2

Question 1

What is ABCD2 used for?

Answer 1

The ABCD² score is a clinical prediction rule used to determine the risk for stroke in the days following a transient ischemic attack.

Question 2

What is ABCD2’s parameters?

Answer 2

1. Age
   >60 +1
2. BP
   >140/90 +1
3. Clinical features of a TIA
   - Unilateral weakness +2
   - Speech disturbance without weakness +1
4. Duration
   - 10-59 minutes +1
   - >60 minutes +2
5. Diabetes +1

Question 3

What do the scores of ABCD2 mean?

Answer 3

ABCD2 score - Risk of stoke at 2 days

0-3
1%

4-5
4%

6-7
8%

Question 4

What is the treatment for a TIA?

Answer 4

Immediate antithrombotic therapy:

give aspirin 300 mg immediately, unless

1. The patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. The patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team

Question 5

What specialist review is needed following a TIA?

Answer 5

1. If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
   Discuss the need for admission or observation urgently with a stroke specialist
2. If the patient has had a suspected TIA in the last 7 days:
   Arrange urgent assessment (within 24 hours) by a specialist stroke physician
3. If the patient has had a suspected TIA which occurred more than a week previously:
   Refer for specialist assessment as soon as possible within 7 days

Advise the person not to drive until they have been seen by a specialist.

Question 6

What is the further management of a TIA?

Answer 6

Clopidogrel

Aspirin + dipyridamole if not tolerated