ABCD2 score and secondary stroke prevention

Wardlaw, Joanna M.; Brazzelli, Miriam; Chappell, Francesca M; Miranda, Héctor; Shuler, Kirsten; Sandercock, Peter; Dennis, Martin

doi:10.1212/wnl.0000000000001780

Cited by 128 publications

(70 citation statements)

References 55 publications

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“…Despite some encouraging reports regarding this score [9], it is difficult to see how to use it in clinical practice, as all patients who have had a TIA need a prompt investigation. Recent meta-analyses found its discriminative value to be low, and that it led to only small revisions in the baseline stroke risk [21,22]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Risk of Stroke after Transient Ischemic Attack

Appelros

Berglund²,

Ström³

2016

Cerebrovasc Dis

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Background: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context. Methods: Riksstroke is the national stroke registry in Sweden. Data from Riksstroke's TIA module, and the national cause-of-death register, for the years 2011 and 2012 were used in this study. Stroke occurrence was monitored via Riksstroke. Cox's regression was used for risk evaluation. The predictive value of the ABCD2 score was assessed by calculating the area under the receiver operating characteristics curve. Results: A total of 15,068 TIA episodes occurred in 14,102 patients. The follow-up time varied between 0 and 819 days, with an average of 417 days. The mortality for all TIA patients during the follow-up time was 7.1%. Of the unique patients, 545 had one or more strokes (3.9%), corresponding to 34 events per 1,000 person years. Significant risk factors for stroke were: age, previous TIA, atrial fibrillation (AF), oral anticoagulant (OAC) treatment, hypertension treatment, and the ABCD2 items speech impairment, unilateral weakness, and diabetes mellitus. The ABCD2 score correlated with a subsequent stroke, but its predictive value was low. Conclusion: The risk of stroke is low after the acute phase of a TIA, probably lower than in previous studies. This may be due to better secondary prevention in recent years. Several risk factors predict stroke, notably hypertensive treatment, which may be inadequate; and AF, where OACs may be under-used. It is difficult to identify the role of the ABCD2 score in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Long-Term Risk of Stroke after Transient Ischemic Attack

Appelros

Berglund²,

Ström³

2016

Cerebrovasc Dis

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“…Some patients who are classified as having low risk on the ABCD 2 score may have important potentially treatable TIA etiologies, such as symptomatic carotid artery stenosis or atrial fibrillation, that require urgent treatment. 23 These limitations have prevented widespread adoption of the ABCD 2 score to triage patients with TIA. 24 The Rotterdam Study 25 followed patients with transient neurologic attacks for 10 years and found an increased risk of stroke not only in patients with focal symptoms (ie, possible TIAs) but also in patients who had transient episodes of nonspecific symptoms.…”

Section: Prognosismentioning

confidence: 99%

Diagnosis and Management of Transient Ischemic Attack

Coutts¹

2017

CONTINUUM: Lifelong Learning in Neurology

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Purpose of Review: This article reviews the diagnosis, investigation, and recommended management after a transient ischemic attack (TIA) and discusses how to make an accurate diagnosis, including the diagnosis of mimics of TIAs. Recent Findings: Up to a 10% risk of recurrent stroke exists after a TIA, and up to 80% of this risk is preventable with urgent assessment and treatment. Imaging of the brain and intracranial and extracranial blood vessels using CT, CT angiography, carotid Doppler ultrasound, and MRI is an important part of the diagnostic assessment. Treatment options include anticoagulation for atrial fibrillation, carotid revascularization for symptomatic carotid artery stenosis, antiplatelet therapy, and vascular risk factor reduction strategies. Summary: TIA offers the greatest opportunity to prevent stroke that physicians encounter. A TIA should be treated as a medical emergency, as up to 80% of strokes after TIA are preventable.

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“…6–9 Moreover, recent studies have challenged the value of the ABCD 2 score for predicting stroke recurrence risk. 10 However, the ABCD 2 score and more recent scores are limited by their derivation from mostly nonneurologist-diagnosed TIA samples and by their development before the 2009 American Heart Association–endorsed TIA definition, which takes into account the presence of infarct on neuroimaging. 11 Prediction scores have not been frequently applied to minor stroke, 9 which may carry the same or higher risk of early recurrent stroke as TIA.…”

mentioning

confidence: 99%