After an ischaemic stroke or a TIA: tests and follow-up for secondary prevention
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected TIA or stroke (recent symptoms)
In the practice
- Capillary blood glucose to rule out hypoglycaemia.
- Ongoing deficit: call 15 (emergency services). Resolved TIA: immediate specialist opinion (neurovascular pathway), patient seen within 24 hours. No laboratory tests in the community.
- CRP, urgently (transient visual disturbance after 50: Horton disease?)if neededTransient amaurosis, “black curtain”, blurred vision or diplopia after age 50: consider giant cell arteritis, measure CRP immediately and, if suspicion is high, start corticosteroid therapy urgently without waiting; a normal ophthalmological examination should not be reassuring [2].
Also consider
- Giant cell arteritis suspected? If giant cell arteritis is suspected, see the corresponding page.
Do not order
- ESR to look for giant cell arteritis: abandoned in favour of CRP; at diagnosis, CRP alone is necessary [2].
Secondary prevention follow-up (after the acute phase)
Fasting laboratory tests
- Lipid profile (LDL-cholesterol target: < 0.70 g/L, i.e. 1.8 mmol/L, for ESO 2022; < 1 g/L for HAS 2014-2018)
- Fasting plasma glucose (to look for unrecognised diabetes)if needednon-French guidelineAn American Family Physician review, based on the 2014 AHA/ASA recommendation, has diabetes looked for in every patient after a TIA or cerebral infarction, by fasting plasma glucose, HbA1c or glucose tolerance test [6]. The more recent 2022 and 2026 reviews do not repeat it [7,8]. NICE asks to check diabetic status before a statin [9]. The HAS sets the HbA1c targets for people with diabetes without addressing this screening [4].
- HbA1c (if type 2 diabetes)if neededType 2 diabetes: HbA1c target ≤ 8% within 6 months after cerebral infarction or TIA, then ≤ 7% thereafter [4].
- Serum creatinine with Cockcroft–Gault clearance (if DOAC)if neededOn dabigatran, rivaroxaban or apixaban: creatinine clearance (Cockcroft–Gault) before treatment, then every year, and more often if it is between 30 and 60 mL/min or if a situation may impair renal function [4].
Also consider
- On a statin? For laboratory monitoring of a statin, see the page “Dyslipidaemia”.
- On a vitamin K antagonist? On VKA, see the page “Treatment: vitamin K antagonist (VKA)”.
Do not order
- Vitamin B supplementation (folate, B12, B6) to “lower homocysteine” without documented hyperhomocysteinaemia: not recommended [4]
Sources (11)
- Assurance maladie. Cartographie des pathologies et des dépenses, effectifs 2024 (data.ameli.fr, jeu « effectifs »), consulté le 24/10/2026.
- Groupe d'étude français des artérites des gros vaisseaux (GEFA), filière FAI²R. Protocole national de diagnostic et de soins (PNDS) : artérite à cellules géantes (Horton). Haute Autorité de santé, janvier 2024.
- National Institute for Health and Care Excellence (NICE). Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Guideline NG128, mai 2019, mise à jour 13 avril 2022.
- Haute Autorité de santé. Prévention vasculaire après un infarctus cérébral ou un accident ischémique transitoire. Recommandation de bonne pratique, juillet 2014, mise à jour juin 2018.
- Choi EY, Nieves GA, Jones DE. Acute Stroke Diagnosis. Am Fam Physician. 2022;105(6):616-624.
- Oza R, Rundell K, Garcellano M. Recurrent Ischemic Stroke: Strategies for Prevention. Am Fam Physician. 2017;96(7):436-440 (d'après la recommandation AHA/ASA de 2014, Kernan et al.).
- Ford B, Peela S, Roberts C. Secondary Prevention of Ischemic Stroke: Updated Guidelines From AHA/ASA. Am Fam Physician. 2022;105(1):99-102 (résumé de la recommandation AHA/ASA 2021).
- Ford B, Dore MM, Koehn TR. Recurrent Ischemic Stroke: Prevention Strategies. Am Fam Physician. 2026;113(1):57-69.
- National Institute for Health and Care Excellence (NICE). Cardiovascular disease: risk assessment and reduction, including lipid modification. Guideline NG238, décembre 2023.
- Dawson J, Béjot Y, Christensen LM, De Marchis GM, Dichgans M, Hagberg G, et al. European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack. Eur Stroke J. 2022;7(3):I-XLI.
- Nederlandse Vereniging voor Neurologie (Pays-Bas). Richtlijn Herseninfarct en hersenbloeding, modules « Risico-aandoeningen na TIA of herseninfarct » et « Streefwaarden (LDL-)cholesterolgehalte », publiés le 26/10/2017, jugés valides le 12/09/2024.