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Objectives:To evaluate frequency, clinical and etiological features, short- and long-term outcomesofearly recurrent TIA.Methods:Prospective observational cohort study enrolling all consecutive patients with TIAreferred to our emergency department (ED) and diagnosed by a vascular neurologist. Expedite assessment and best secondary prevention were performed within 24h. Primary endpoints were stroke and a composite outcome including stroke, acute coronary syndrome and vascular death at 3, 12 and,for a subset of patients, 60 months; secondary outcomeswere TIA relapse, cerebral hemorrhage, new onset atrial fibrillation and death from other causes. Concordance between index TIA and subsequent stroke etiologies was also evaluated.Results:A total of 1035 patients (822 single TIA, 213 recurrent TIA =21%) were enrolled from August2010 to December 2017. Capsular warning syndrome and large-artery atherosclerosis showed the strongest relationship with early recurrent TIA. The risk of stroke was significantly higher in the early recurrent TIA subgroup at each follow-upand most stroke episodes occurred within 48h of index TIA. TIA with lesion, dysarthria and leukoaraiosiswere 3- and 12-month independent predictors of stroke incidence after early recurrent TIA subgroup. Index TIA and subsequent stroke etiologies showed substantial concordance. An ABCD3 score>6 predictedahigher risk of stroke rcurrenceover the entire follow-up.Conclusions:Our study was the first to evaluate long-term outcome after early recurrentTIA. Our observations support the importance of promptly detecting and treating patients with earlyrecurrent TIAs in order to reduce the high early and long-term risk of poor clinical outcomes.

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA 2 DS 2 -VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P =0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P =0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P =0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P =0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P =0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.