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Stroke After TIA

More than 15% of patients can be expected to have a stroke within 90 days of TIA presentation.

During the past five years, transient ischemic attack (TIA) has come to be regarded as angina of the brain. This new thinking arose after observational studies raised awareness of the frequency of stroke after TIA, but the actual incidence is uncertain because of varying methodology in the relevant studies.

These authors performed a meta-analysis of 11 studies that included a combined total of more than 7000 patients. To determine if a stroke occurred after the index TIA event, some of the studies relied on record review (passive ascertainment) while other studies interviewed patients at predetermined intervals after the index event (active ascertainment). The latter method is thought to be more reliable.

The overall rate of stroke after TIA was 3.5% by 2 days, 8.0% by 30 days, and 9.2% by 90 days. When only the three studies that used active outcome ascertainment were analyzed, the corresponding rates were 9.9%, 13.4%, and 17.3%.

Comment: As the U.S. population ages, cerebrovascular disease will become much more prevalent. Emergency departments can play a significant role in stroke prevention by being attentive to symptoms that may represent cerebral ischemia and by ensuring that patients are evaluated promptly. A recent study (Journal Watch Emergency Medicine Sep 7 2007) showed that the work-up can be done safely and expeditiously in an ED observation unit.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine January 18, 2008

Citation(s):

Wu CM et al. Early risk of stroke after transient ischemic attack: A systematic review and meta-analysis. Arch Intern Med 2007 Dec 10; 167:2417.

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