I would split it into lifestyle factors and then medication. For medication, we would be using medication to stop stickiness of the blood. If it is a clot, it is due to the blood being too sticky. Traditionally we have used aspirin, but now we have moved more towards a medication called clopidogrel, which is very similar but thought to be slightly more effective amongst some patients at preventing a stroke.
There is a lot of press about statins and they are the most commonly prescribed medication in the UK at the moment, but actually this is one of the scenarios where they are thought to be very effective at reducing the risk of a stroke. That is independent of some patient’s levels so even in patients with relatively normal looking cholesterol, we may put them on statins especially if they show signs of furring of the blood vessels. Finally, it is about treating other things like blood pressure. We would typically target blood pressure with a top number of 130 and the bottom number of 80 and we would very aggressively treat high blood sugars or the condition of diabetes. It is always an opportunity to look at your lifestyle factors. Am I doing enough exercise, what is my alcohol intake, what is the stress in my life, am I sleeping well? These things have an important interplay and are important for outcomes later on following TIA and strokes.