Early Treatment After TIA Greatly Reduces Stroke Risk

Stroke risk after transient ischemic attack (TIA) can be reduced by such treatments as antiplatelet agents, antihypertensive medications, statins, anticoagulation, and endarterectomy. Because risk is greatest in the first week, can early intervention prevent progression to stroke?

Researchers examined 90-day risk for stroke in a prospective population-based study of all cases of incident and recurrent TIA and stroke among primary care patients in Oxfordshire, England. In the first phase of the study, general practitioners made non-urgent referrals to a minor-stroke clinic for patients who did not need hospital admission. Treatment recommendations were forwarded to the general practitioners; treatment was not initiated in the stroke clinic. In the second phase, patients who did not need hospital admission had rapid access to the stroke clinic without an appointment, and treatment was initiated in the clinic.

Overall, 310 patients in phase 1 and 281 in phase 2 were referred to the clinic. Median delay to assessment in the stroke clinic was reduced from 3 days in phase 1 to less than 1 day in phase 2. Time until treatment was reduced from 20 days to 1 day. Sixteen patients in phase 1 had strokes after TIA, compared with one patient in phase 2. Risk for recurrent stroke at 90 days was 10.3% in phase 1 and 2.1% in phase 2 (adjusted hazard ratio, 0.20). Bleeding events at 30 days were similar in the two groups.

The authors conclude that early treatment after TIA or minor stroke reduces the risk for early recurrent stroke by 80%. They call for enhanced public education campaigns and note that additional follow-up is needed to assess long-term outcomes.