From D. Garth Sullivan at Indox Consulting:
Rapid assessment and treatment of a first transient ischemic attack (TIA) or minor ischemic stroke dramatically reduces risk for subsequent major stroke.
Two separate studies - one in the Lancet and the other in Lancet Neurology - show that such an approach reduces recurrent stroke risk by about 80%.
Initially presented in June 2007 at the 16th European Stroke Conference and reported by Medscape Neurology & Neurosurgery at that time, the Early Use of Existing Preventive Strategies for Stroke (EXPRESS) study from Oxford University, in the United Kingdom, showed a relative risk reduction at 90 days in major recurrent stroke of more than 80% among patients who received early, aggressive treatment for TIA or minor stroke.
"Our data indicate that urgent assessment and early initiation of a combination of existing preventive treatments can reduce risk of early recurrent stroke after TIA or minor stroke by about 80%. . . . Extrapolated across the UK population, this equates to the prevention of nearly 10,000 strokes per year," the EXPRESS investigators write.
The study is published online October 9 in the Lancet.
New Standard for Treatment of TIA
Known as the SOS-TIA program, neurological, arterial, and cardiac imaging that took place within 4 hours of admission assessed TIA patients. The study's primary outcome was stroke within 90 days.
The study is published online October 9 in Lancet Neurology.
The study included 1085 patients with suspected TIA who entered the SOS-TIA program between January 2003 and December 2005. Of these, 574 were seen within 24 hours of symptom onset; 701 had confirmed TIA or minor stroke and 144 had possible TIA.
The 643 patients with confirmed TIA all began a stroke prevention program, with 43 individuals undergoing urgent carotid revascularization and 44 individuals treated for atrial fibrillation with anticoagulants.
At 90 days, the stroke rate was 1.24%, compared with an expected rate of 5.96%. According to the authors, this suggests immediate treatment through a dedicated clinic reduced the risk for recurrence of TIA by almost 80%.
"We show prompt evaluation and treatment of patients with TIA in a dedicated outpatient unit is associated with a lower-than-expected risk of subsequent stroke. Because almost three-quarters of patients were discharged home on the same day as the diagnosis, the TIA clinic is also likely to involve lower costs and greater patient satisfaction about their management than is treatment without such a clinic," they write.
In an accompanying comment in Lancet Neurology, Walter Kernan, MD, and Joseph Schindler, MD, from Yale University School of Medicine, in New Haven, Connecticut, say Dr. Amarenco and colleagues have forged an important new paradigm for the early treatment of TIA and minor ischemic stroke.
"Rapid assessment and intervention is emerging as the new standard for TIA care. . . . We believe that the time is right to accept this new standard and to begin use of rapid access as a platform for rigorous testing of innovative strategies for TIA care," they write.