Why TIA notes go wrong

The two failure modes are opposite. One is under-reaction: a resolved deficit is written up as "TIA, aspirin, follow up with PCP" and the carotid or the atrial fibrillation is never looked for. The other is over-documentation without decisions: a long template that lists every test but never states which antithrombotic, for how long, and where the patient goes tonight. This builder forces both decisions into the note in plain sentences, and it flags the two contradictions residents most often carry into a TIA plan — atrial fibrillation with an antiplatelet-only plan, and isolated vertigo written up as a high-risk event.

What the builder decides

From the risk score, imaging, and rhythm it selects the antithrombotic strategy (aspirin, clopidogrel, DAPT × 21 days, ticagrelor-aspirin, or anticoagulation for AF started on day 1–2 when there is no infarct), the statin and LDL goal, the long-term blood-pressure target, the urgent workup list (MRI with DWI within 24 h, CTA or MRA, telemetry, echocardiogram, prolonged monitoring if nothing is found), and the disposition with the conditions that make early discharge safe. Every default is editable and the antithrombotic field overrides the rule set.

Scores, not guesses

The ABCD² and Canadian TIA Score fields link to the site's calculators so the number in the note is the number you actually computed. If a DWI lesion is present, the builder tells you this is now a minor stroke and points you at the acute ischemic stroke builder, whose plan is different in ways that matter (admission monitoring, timing of anticoagulation by infarct size).

Frequently asked questions

Does the builder decide between admission and discharge for me?

It writes the disposition you select and, for early discharge, spells out the conditions the evidence supports: antithrombotic started, imaging done or booked within 24 hours, and TIA clinic within 24 to 48 hours. If those cannot be met, it recommends admission or observation. The choice remains yours and your attending's.

Why does the plan use aspirin plus clopidogrel for only 21 days?

CHANCE and POINT showed the stroke-prevention benefit of dual antiplatelet therapy after high-risk TIA or minor stroke is front-loaded into the first three weeks, while the bleeding risk keeps rising. The builder writes the 21-day course and the switch to a single agent so the stop date is in the chart.

Can I use this note for a patient with a DWI lesion?

The builder will warn you that a DWI lesion makes the event a minor ischemic stroke and suggest the acute ischemic stroke builder, which handles admission monitoring, reperfusion status, and anticoagulation timing by infarct size.

References

  1. Kleindorfer DO, et al. 2021 guideline for the prevention of stroke in patients with stroke and TIA. Stroke. 2021;52:e364–e467.
  2. Wang Y, et al. CHANCE. N Engl J Med. 2013;369:11–19. · Johnston SC, et al. POINT. N Engl J Med. 2018;379:215–225.
  3. Rothwell PM, et al. Effect of urgent treatment of TIA and minor stroke on early recurrent stroke (EXPRESS). Lancet. 2007;370:1432–1442.
  4. Perry JJ, et al. Prospective validation of the Canadian TIA Score. BMJ. 2021;372:n49.