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Stroke After TIA: How Likely and How Soon?

• Stroke likely after TIA
• emergent evaluation and treatment after TIA
• Also education

Stroke likely after TIA

Caroline Poplin, 2 Jun 2009 9:17 PM EST

Competing interests: None declared

I am a general internist. How does this change management? If we do an urgent evaluation and find a high level carotid blockage, then perhaps a stent or endarterectomy, but otherwise, aside from treating risk factors (unlikely to prevent an impending stroke) what can we do??

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emergent evaluation and treatment after TIA

Cleveland Sharp, Urgent Care Albuquerque NM, 3 Jun 2009 6:16 PM EST

Competing interests: None declared

Quite the contrary, articles listed in a quick search of this site alone suggest that aggressive risk factor management does make a difference -- just as it does for CAD. Quickly, I would cite at least http://emergency-medicine.jwatch.org/cgi/content/full/2007/1018/1 suggesting that carotid ultrasound, statins, anti-platelet agents and careful blood pressure management can result in 80% risk reduction in the ensuing 30 days.

Since I work in an Urgent Care where it's hard to do a lot of this, I'd appreciate hearing from ER and Primary Care colleagues about how we realize these benefits.

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Also education

Arthur J Lockhart, 11 Jun 2009 3:05 PM EST

Competing interests: None declared

Also, I would suggest especially intensive patient & family education about signs and symptoms of stroke, and need for EMS transport to certified stroke center in the event signs or symptoms are suspected. Acute intervention, including intra-arterial intervention can save the patient from an evolving stroke should one occur. More than 50% of patients never get to the hospital at all, or in time, according to the Coverdell Registry. JHACO Primary Stroke Centers can be found here: http://www.strokecenter.org/strokecenters.html

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