{ "schema_version": 1, "kind": "condition", "id": "tia-referral", "name": "Transient Ischaemic Attack (urgent referral)", "category": "chronic", "sources": "NICE Guideline NG128: Stroke and transient ischaemic attack 2019 · ESO Guidelines for the management of ischaemic stroke 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (clopidogrel monograph) · Transient Ischemic Attack - StatPearls - NCBI Bookshelf - disease-level clinical article (tia-referral-full.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (ticagrelor monograph, acute coronary syndrome regimen)", "review_status": "reviewed", "verified_against": "NICE Guideline NG128: Stroke and transient ischaemic attack 2019 · Egyptian National Drug Formulary - Cardiovascular 2024 (clopidogrel monograph) · Transient Ischemic Attack - StatPearls - NCBI Bookshelf - disease-level clinical article (tia-referral-full.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (ticagrelor monograph, acute coronary syndrome regimen)", "verified_date": "2026-08", "treatments": [ { "id": 1723, "generic": "Acetylsalicylic acid", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 300.0, "adult_dose": "300 mg once daily orally immediately in primary care (if no suspicion of intracranial hemorrhage or active bleeding) until specialist TIA assessment within 24 hours", "adult_duration": null, "dose_source": "NICE Guideline NG128: Stroke and transient ischaemic attack 2019 for the indication and the adult dose; the paediatric band above is from Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph): \"Child 1 month-11 years: 1-5 mg/kg once daily (max. per dose 75 mg); Child 12-17 years: 75 mg once daily\", given there for antiplatelet prevention of thrombus formation after cardiac surgery - not for this indication.", "rationale": "Immediate loading dose of aspirin 300 mg in primary care significantly reduces early recurrent stroke risk after TIA while urgent specialist evaluation is arranged.", "cautions": [ "URGENT SPECIALIST REFERRAL REQUIRED: All suspected TIA patients must be assessed by a stroke specialist or TIA clinic within 24 hours.", "DO NOT give aspirin loading dose if patient is already taking anticoagulation (e.g., warfarin, DOACs) or has an active bleeding disorder; refer urgently without aspirin.", "Advise patient NOT to drive until evaluated and cleared by stroke specialist assessment.", "Everyone who has had a suspected TIA should have specialist assessment and investigation within 24 hours of the onset of symptoms." ], "peds_mgkg_low": 1.0, "peds_mgkg_high": 5.0, "peds_max_mg": 75.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Child 1 month-11 years: 1-5 mg/kg once daily, no single dose above 75 mg; Child 12-17 years: 75 mg once daily. NICE NG128 is an adult guideline and states no paediatric dose - it gives adult aspirin as 300 mg daily. A transient ischaemic attack in a child is a referral, not a primary-care prescription: it points to sickle cell disease, cardiac disease, an arteriopathy or a clotting disorder, and needs paediatric neurology.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 10, "high_mg": 50, "capped": false }, { "weight_kg": 20, "low_mg": 20, "high_mg": 75, "capped": true }, { "weight_kg": 30, "low_mg": 30, "high_mg": 75, "capped": true }, { "weight_kg": 40, "low_mg": 40, "high_mg": 75, "capped": true } ], "brands": [ { "trade_name": "ASPOCID 300 MG 200 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 80.0, "pack_count": 200, "unit_price": 0.4, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "tia-referral" }, { "id": 1722, "generic": "Clopidogrel", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 75.0, "adult_dose": "75 mg once daily (or 300 mg loading dose if aspirin-intolerant) after specialist evaluation", "adult_duration": "Long-term secondary prevention", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (clopidogrel monograph)", "rationale": "Antiplatelet that inhibits P2Y12-mediated platelet aggregation, used for long-term secondary prevention of further TIA or ischaemic stroke after specialist evaluation; also an option in the acute setting for patients with genuine aspirin hypersensitivity.", "cautions": [ "First-line antiplatelet agent for long-term secondary prevention of TIA/ischaemic stroke after specialist evaluation (NICE TA210 / NG128); also used in acute setting for patients with true aspirin hypersensitivity.", "Discontinue 5-7 days before elective surgical procedures after consulting specialist.", "Monitor for signs of gastrointestinal bleeding or rash.", "In patients with recent lacunar stroke (within 180 days), adding clopidogrel to aspirin does not reduce stroke recurrence but increases major hemorrhage and all-cause mortality.", "The risk of stroke is highest in the first 48 hours after a transient ischaemic attack, and about 20% of patients have a stroke within 3 months if they are not evaluated and treated.", "RED FLAG - A patient with high-risk features needs hospital admission for acute management, not only an outpatient appointment.", "The high-risk features are a raised clinical risk score, a subacute or acute infarct on CT or MRI, 50% or greater stenosis of the ipsilateral carotid, another transient ischaemic attack within the last month, or an acute cardiac process or arrhythmia.", "A reassuringly low clinical risk score does not exclude critical carotid artery stenosis, which can present that way.", "Complete resolution of the symptoms does not make the episode benign; sudden unilateral weakness, facial droop, speech difficulty, vision loss, sensory change, dizziness or gait instability still require immediate emergency evaluation.", "Tell the patient to call emergency services rather than making their own way in or waiting to see whether the symptoms come back.", "Clopidogrel needs CYP2C19 to become active, and a loss-of-function variant common in Central and South Asian patients reduces its effect.", "Transient loss of vision described as a curtain rising or descending points to a problem in the internal carotid artery.", "Where atrial fibrillation or another cardioembolic source is identified, oral anticoagulation, not an antiplatelet, is the recommended secondary prevention.", "Roughly half of hospital admissions for suspected stroke turn out to be mimics, so alternative diagnoses must be actively excluded.", "Symptomatic internal carotid artery stenosis of 70% or greater is an indication for revascularisation." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric neurology supervision required.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "BLOTAGRIL 75MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES", "price_egp": 33.0, "pack_count": 30, "unit_price": 1.1, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ITOLAVIX 75 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > INTERNATIONAL TRADING OFFICE", "price_egp": 54.0, "pack_count": 30, "unit_price": 1.8, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BORGAVIX 75MG 30 F.C. TABLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 66.0, "pack_count": 30, "unit_price": 2.2, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SIGAGREL 75MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLOPACIRC 75 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "COPAD PHARMA", "price_egp": 117.0, "pack_count": 30, "unit_price": 3.9, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "THROMBO 75MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 123.0, "pack_count": 30, "unit_price": 4.1, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PLATENOR 75MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM > EGYPHARMA-EGYPT", "price_egp": 150.0, "pack_count": 30, "unit_price": 5.0, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PLAVIX 75 MG 28 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI WINTHROP > SANOFI", "price_egp": 311.0, "pack_count": 28, "unit_price": 11.11, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "tia-referral" }, { "id": 1724, "generic": "Ticagrelor", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 90.0, "adult_dose": "Initially 180 mg for 1 dose, then 90 mg twice daily, in combination with aspirin. That is the formulary's acute coronary syndrome regimen; it states no regimen for TIA or stroke.", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (ticagrelor monograph, acute coronary syndrome regimen)", "rationale": "Two documents, one claim each, and the row says which is which. The INDICATION comes from this condition's own article, which names ticagrelor squarely: it is active as given, so no genetic difference in enzyme handling can blunt it, which makes it the logical pick where the patient carries a loss-of-function CYP2C19 variant for clopidogrel. The DOSE comes from the Egyptian formulary's ticagrelor monograph, whose own indications are acute coronary syndrome and prior myocardial infarction - TIA and stroke are not among them, which under the August 2026 ruling is silence, not prohibition. The formulary's contraindications ARE a bar and are printed on the row.", "cautions": [ "CONTRAINDICATED on the formulary's own list: hypersensitivity to ticagrelor - angioedema being the example given - or to anything else in the product; bleeding that is active and pathological, a peptic ulcer for instance; any previous intracranial haemorrhage; and severe hepatic impairment. A previous intracranial haemorrhage rules this drug out, and a TIA patient is exactly the population in whom that history must be asked for.", "The dose above is NOT a TIA dose. What the formulary licenses is the prevention of atherothrombotic events after an acute coronary syndrome, and in the patient with a past myocardial infarction who is at high risk of one - the 180 mg load and 90 mg twice daily are that regimen, used here because no document available to this project states a TIA-specific one.", "The article's evidence is for a short course started early: in CHANCE-2, ticagrelor with aspirin outperformed clopidogrel with aspirin at 1 year, provided it was begun inside 24 hours and run for 21 days. The formulary allows up to a year, but for acute coronary syndrome. Neither document states a duration for TIA.", "Start after specialist TIA assessment, not instead of it - this card is an urgent-referral pathway.", "Discontinue at least 5 days before surgery where bleeding risk is high." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose is stated in either document; the formulary's ticagrelor monograph gives adult dosing only.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "THROMBOLINTA 90MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 219.75, "pack_count": 30, "unit_price": 7.33, "strength_mg": 90.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LINTARAM 90MG 30+20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 203.25, "pack_count": 20, "unit_price": 10.16, "strength_mg": 90.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TICALOGUARD 90 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 411.0, "pack_count": 30, "unit_price": 13.7, "strength_mg": 90.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WESTGRELOR 90MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA", "price_egp": 137.0, "pack_count": 10, "unit_price": 13.7, "strength_mg": 90.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRILIQUE 90MG 56 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTRA ZENECA", "price_egp": 1064.0, "pack_count": 56, "unit_price": 19.0, "strength_mg": 90.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LINGABRIQUE 90 MG 28 ODT", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 382.0, "pack_count": null, "unit_price": null, "strength_mg": 90.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "tia-referral" } ] }