Four-Year Follow-Up of Transient Ischemic Attacks, Strokes, and Mimics

Abstract

The traditional definition of TIA as an acute loss of focal cerebral or ocular function lasting <24 hours presumed to be caused by embolic or thrombotic vascular disease was used.15 However, patients with resolution of symptoms within 24 hours but with recent infarcts Background and Purpose-There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database. Methods-All patients referred between April 2010 and May 2012 were retrospectively identified and outcomes determined.End points were stroke, myocardial infarction, any vascular event (TIA, stroke, or myocardial infarction), and all-cause death. Data were analyzed by survival analysis. Results-Of 1067 patients, 31.6% were TIAs, 18% strokes, and 50.4% mimics. Median assessment time was 4.5 days from onset and follow-up was for 34.9 months. Subsequent strokes occurred in 7.1% of patients with TIA, 10.9% of patients with stroke, and 2.0% of mimics at the end of follow-up. Stroke risk at 90 days was 1.3% for patients diagnosed as TIA or stroke. Compared with mimics, hazard ratios for subsequent stroke were 3.88 (1.90-7.91) for TIA and 5.84 (2.81-12.11) for stroke. Hazard ratio for any subsequent vascular event was 2.91 (1.97-4.30) for TIA and 2.83 (1.81-4.41) for stroke.Hazard ratio for death was 1.68 (1.10-2.56) for TIA and 2.19 (1.38-3.46) for stroke. Conclusions-Our results show a lower 90-day stroke incidence after TIA or minor stroke than in earlier studies, suggesting that rapid access daily TIA clinics may be having a significant effect on reducing strokes. (Stroke.

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

“…Once again, this may have stemmed from differences in patient characteristics between the two studies and the larger number of patients in our study, along with different preoperative variable inclusions. Although our results show that a history of transient ischemic attack is a predictor of CVA, paradoxically, history of CVA was not independently associated with 30-day CVA rates [10]. An explanation for this incongruity may be that patients with previous CVA may have been receiving anticoagulants before surgery thereby preventing perioperative strokes, whereas patients with only a history of transient ischemic attack may not have had this previous prophylaxis.…”

Contraction of Blood Clots Is Impaired in Acute Ischemic Stroke

“…47 Our findings suggest that a premorbid status and predisposition to thrombosis, such as are seen in TIA and ischemic stroke, are critical determinants for the ability of clots to contract rather than a transitory episode of cerebral vascular occlusion and ischemia that may or may not result in persistent thrombosis and/or thromboembolism. While rapid treatment of TIA has the potential to help reduce the incidence of ischemic stroke, 48,49 the TIA samples in our study were examined prior to the administration of any anticoagulant, thrombolytic or antiplatelet drugs.…”

Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011 to 2012

“…15 Rapid access TIA clinics improve outcomes and are cost effective but the provision of such clinics may be challenging in some healthcare settings. [25][26][27] There is unlikely to be a one size fits all solution with the provision of TIA services varying depending on local factors.…”