1.  Initiate antiplatelet therapy as soon as intracranial hemorrhage is excluded on imaging. For most patients not receiving IV thrombolysis, give 325 mg aspirin.

 

2. Dual Antiplatelet Therapy for Minor Stroke or High-Risk TIA: 

In patients with minor non-cardioembolic stroke (NIHSS ≤5) or high-risk TIA (ABCD² ≥4) , short-term DAPT (aspirin + clopidogrel) is indicated. DAPT significantly reduces 90-day recurrent stroke risk without excessive bleeding in this population.

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3. Early Cardiac Workup: Look at the ECG on stroke/TIA patients to screen for atrial fibrillation or other arrhythmias (yield ~5% for new AFib). AFib is a common cardioembolic source. If the initial ECG negative but stroke is cryptogenic or suspicion for AFib remains high (e.g., older age, embolic pattern on imaging), arrange expedited follow up and prolonged monitoring. 

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4. Symptomatic carotid stenosis is defined as an ipsilateral TIA or nondisabling ischemic stroke. Intervention on symptomatic Carotid stenosis (>50%) is most beneficial when performed within 1-2 weeks of the index event. Most ER stroke CT scans will include carotid evaluation in the cuts. 

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5. Risk factor optimization should be considered: Address BP, lipids (start Atorvastatin 40-80 mg/Rosuvastatin 20-40 mg) and advise about smoking cessation.