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Stroke After TIA: How Likely and How Soon?

Risk for stroke within 24 hours after TIA was 5% in this large population-based study.

Urgent intervention after transient ischemic attack (TIA) is highly effective for preventing recurrent stroke. Most guidelines recommend neurological evaluation within 24 hours after symptom onset, yet some patients with TIA have strokes within that 24-hour period. As part of a prospective study of all strokes and TIAs in a population of 91,106 individuals in Oxfordshire, U.K. (the Oxford Vascular Study), researchers assessed the risk for stroke within 24 hours after a first TIA and the predictive value of the ABCD² risk scoring system.

Among 488 patients with first TIAs from 2002 to 2007, the risk for stroke was 1.2% within 6 hours, 2.0% within 12 hours, and 5.1% within 24 hours. Of the 59 strokes that occurred within 30 days after TIA, 25 (42%) occurred within the first 24 hours. Nineteen of the 25 patients who had strokes within 24 hours had ABCD² scores 5. Risk for stroke within 24 hours after TIA was 2.0% in patients with ABCD² scores 4, 6.5% with scores of 5, 11.8% with scores of 6, and 33.0% with scores of 7. Similarly, patients with scores 5 had greater risk for stroke than those with lower scores within 6 hours (2.6% vs. 0.3%) and within 12 hours (4.7% vs. 0.3%).

Comment: The finding of a substantial rate of stroke within 24 hours after presentation with TIA underscores the need for healthcare workers to educate patients to seek emergency care if they have symptoms of stroke, even if they are minor or resolved, and for primary care physicians to quickly refer patients for emergent evaluation. Although stroke risk correlates with the ABCD² score, even patients in the lowest risk ABCD² group have a 2% risk for stroke within 24 hours, which is sufficient to warrant emergent evaluation.

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine June 1, 2009

Citation(s):

Chandratheva A et al. Population-based study of risk and predictors of stroke in the first few hours after a TIA. Neurology 2009 Jun 2; 72:1941.

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Reader Remarks:

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• Stroke likely after TIA
  Caroline Poplin, 2 Jun 2009 9:17 PM EST
  I am a general internist. How does this change management? If we do an urgent evaluation and find a high... [more]
• emergent evaluation and treatment after TIA
  Cleveland Sharp, Urgent Care Albuquerque NM, 3 Jun 2009 6:16 PM EST
  Quite the contrary, articles listed in a quick search of this site alone suggest that aggressive risk factor management does... [more]
• Also education
  Arthur J Lockhart, 11 Jun 2009 3:05 PM EST
  Also, I would suggest especially intensive patient & family education about signs and symptoms of stroke, and need for EMS... [more]