TIA can be a harbinger of ischemic stroke and represents an opportunity to lower risk if managed appropriately. Current treatment guidelines recommend treatment with antiplatelet within 12-24 hours of symptom onset. We implemented a pathway January 1, 2023 to guide management of TIA patients in an academic ED with the goal of improving time to appropriate therapy.

Data from June 1, 2022 to April 30, 2024 was queried for patients with suspected TIA  entered into a navigator or listed as a discharge diagnosis. Two independent clinicians determined if diagnosis and administration of antiplatelet therapy were appropriate. Data before and after January 2023 were analyzed with descriptive statistics.

89 of 90 consecutive ED patients with TIA were included, 57 of which presented after pathway rollout. One  was excluded who was already appropriately on dual antiplatelet  prior to presentation. The percentage of patients who appropriately received anti-platelet therapy was 96.9% pre-pathway versus 98.3% post-pathway (p= 1.00). Median time to antiplatelet (25^th, 75th quartiles) was 407 minutes (205, 670) pre-pathway versus 395 minutes (178, 656) post-pathway (p= 0.633). atients who received antiplatelet therapy within 12 hours of arrival to the ED was 75.0% pre-pathway and 80.8% post-pathway (p=0.576). The percentage of patients who received antiplatelet therapy within 24 hours of arrival to the ED was 92.9% pre-pathway and 98.1% post-pathway (p=0.279).

There was improvement in appropriate administration of and time to antiplatelet therapy following the implementation of a pathway for managing patients with TIA in the ED, though not statistically significant and limited by small sample size. Future directions are focused on improving pathway adherence by incorporating the pathway and its relevant orders directly into the EMR.