The high risk of stroke immediately after transient ischemic attack

Hill, Michael D.; Yiannakoulias, Nikolaos; Jeerakathil, Thomas; Tu, Jack V.; Svenson, Lawrence W.; Schopflocher, Donald

doi:10.1212/01.wnl.0000129482.70315.2f

Cited by 344 publications

(262 citation statements)

References 22 publications

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“…The risk of stroke after a transient ischemic attack (TIA) is high especially during the first 3 months and figures of 10–20% have been reported (Coull, Lovett, & Rothwell, 2004; Eliasziw, Kennedy, Hill, Buchan, & Barnett, 2004; Eriksson & Olsson, 2001; Hill et al., 2004; Purroy et al., 2007). Similar results have been reported for minor, moderate stroke patients (Coull et al., 2004) or considerably lower figures (Eliasziw et al., 2004; Eriksson, & Link, 1983).…”

Section: Introductionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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ObjectivesTo assess long‐term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given.Materials and MethodsRetro/prospective follow‐up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011.ResultsA total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first‐line treatment had beneficial effects on survival: AC OR 0.67 (0.5–0.9), APT 0.67 (0.52–0.88) versus untreated.ConclusionsPatients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.

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Section: Introductionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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“…Approximately 20% of patients who have had a transient ischemic attack (TIA) or minor stroke will have a recurrent vascular event within 1 year [2]. The risk of recurrent ischemic stroke is especially high within the first week after a minor stroke or TIA [3].…”

Section: Antiplatelet Agents In Secondary Stroke Preventionmentioning

confidence: 99%

Antiplatelet Agents for Stroke Prevention

Yip

Benavente

2011

Neurotherapeutics

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Stroke is one of the leading causes of disability and death. Ischemic stroke is a syndrome with heterogeneous mechanisms and multiple etiologies, rather than a singularly defined disease. Approximately one third of ischemic strokes are preceded by another cerebrovascular ischemic event. Stroke survivors are at high risk of vascular events (i.e., cerebrovascular and cardiovascular events), particularly during the first several months after the ischemic event. The use of antiplatelet agents remains the fundamental component of secondary stroke prevention. Based on the available data, antiplatelet agents should be used for patients with noncardioembolic stroke. The use of combination therapy (aspirin plus clopidogrel) has not been proven to be effective or safe to use for prevention of early stroke recurrence or in long-term treatment. There is no convincing evidence that any of the available antiplatelet agents are superior for a given stroke subtype. Currently, the uses of aspirin, clopidogrel, or aspirin combined with extended release dipyridamole are all valid alternatives after an ischemic stroke or transient ischemic attack. However, to maximize the effects of these agents, the treatment should be initiated as early as possible and be continued on a lifelong basis.

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“…1,2 TIAs are relatively common, having an annual incidence of 68 per 100,000. 3 Although relatively benign, given that TIAs cause temporary neurological deficits, they are important because they identify individuals at high risk of subsequent stroke. Previous studies have estimated this risk to be 4%-10% within 7 days of TIA, and increases to 8%-12% by 90 days.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have estimated this risk to be 4%-10% within 7 days of TIA, and increases to 8%-12% by 90 days. [3][4][5][6][7][8][9][10][11][12] Stroke is a serious and significant health and economic burden, because it is the leading cause of adult disability, the second leading cause of dementia, and the third leading cause of death. [13][14][15] In addition, it results in the use of large amounts of health care system resources.…”

Section: Introductionmentioning

confidence: 99%

National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk

Perry

Losier

Stiell

et al. 2015

CJEM

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Introduction: Five percent of transient ischemic attack (TIA) patients have a subsequent stroke within 7 days. The Canadian TIA Score uses clinical findings to calculate the subsequent stroke risk within 7 days. Our objectives were to assess 1) anticipated use; 2) component face validity; 3) risk strata for stroke within 7 days; and 4) actions required, for a given risk for subsequent stroke. Methods: After a rigorous development process, a survey questionnaire was administered to a random sample of 300 emergency physicians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique. Results: From a total of 271 eligible surveys, we received 131 (48.3%) completed surveys; 96.2% of emergency physicians would use a validated Canadian TIA Score; 8 of 13 components comprising the Canadian TIA Score were rated as Very Important or Important by survey respondents. Risk categories for subsequent stroke were defined as minimalrisk: <1%; low-risk: 1%-4.9%; high-risk 5%-10%; critical-risk: > 10% risk of subsequent stroke within 7 days. Conclusion: A validated Canadian TIA Score will likely be used by emergency physicians. Most components of the TIA Score have high face validity. Risk strata are definable, which may allow physicians to determine immediate actions, based on subsequent stroke risk, in the emergency department.

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The high risk of stroke immediately after transient ischemic attack

Abstract: Although stroke is common after TIA, the early risk is not predicted by clinical and demographic factors. Validated models to identify which patients require urgent intervention are needed.

Cited by 344 publications

References 22 publications

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Antiplatelet Agents for Stroke Prevention

National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk

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