Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services

Abstract

Objective To estimate the very early stroke risk after a transient ischaemic attack (TIA) or minor stroke and thereby inform the planning of effective stroke prevention services. Design Population based prospective cohort study of patients with TIA or stroke. Setting Nine general practices in Oxfordshire, England, from April 2002 to April 2003. Participants All patients who had a TIA (n = 87) or minor stroke (n = 87) during the study period and who presented to medical attention. Main outcome measures Risk of recurrent stroke at seven days, one month, and three months after TIAs and minor strokes. Results The estimated risk of recurrent stroke was 8.0% (95% confidence interval 2.3% to 13.7%) at seven days, 11.5% (4.8% to 18.2%) at one month, and 17.3% (9.3% to 25.3%) at three months after a TIA. The risks at these three time periods after a minor stroke were 11.5% (4.8% to 11.2%), 15.0% (7.5% to 22.5%), and 18.5% (10.3% to 26.7%). Conclusions The early risks of stroke after a TIA or minor stroke are much higher than commonly quoted. More research is needed to determine whether these risks can be reduced by more rapid instigation of preventive treatment.

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

“…Case fatality rates due to stroke vary around the world (Feigin, Lawes, Bennett, Barker‐Collo, & Parag, 2009) and depend on the severity of stroke, the subtype of stroke and other factor (Coull et al., 2004; Eliasziw et al., 2004; Eriksson & Olsson, 2001; Evans, Harraf, Donaldson, & Kalra, 2002; Evans, Perez, Yu, & Kalra, 2000; Feigin et al., 2009; Jackson & Sudlow, 2005; de Jong, Lodder, Kessels, & van Raak, 2004; Norrving, 2003; Vaartjes, O'Flaherty, Capewell, Kappelle, & Bots, 2013; Yokota, Minematsu, Hasegawa, & Yamaguchi, 2004). Stroke mortality has decreased in many countries, but the incidence has not (Feigin et al., 2009; Vaartjes et al., 2013).…”

“…Similar results have been reported for minor, moderate stroke patients (Coull et al., 2004) or considerably lower figures (Eliasziw et al., 2004; Eriksson, & Link, 1983). However, after 14–years follow up a cumulative risk of 63.2% (CI 55.6–71) of having a recurrent stroke was reported in a previous study that included different subgroups of stroke patients (Eriksson & Olsson, 2001).…”

“…The risk of stroke after a transient ischemic attack (TIA) is high especially during the first 3 months and figures of 10–20% have been reported (Coull, Lovett, & Rothwell, 2004; Eliasziw, Kennedy, Hill, Buchan, & Barnett, 2004; Eriksson & Olsson, 2001; Hill et al., 2004; Purroy et al., 2007). Similar results have been reported for minor, moderate stroke patients (Coull et al., 2004) or considerably lower figures (Eliasziw et al., 2004; Eriksson, & Link, 1983).…”

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

“…Different from what we expected, METS showed only a trend of increased risk of recurrent stroke and did not reach statistical significance. Even with medical intervention, minor stroke and TIA still led to a high risk of recurrence that could raise the disability rate 14, 15. METS was frequently found in patients with minor stroke and TIA 5.…”

“…Minor ischemic stroke and TIA account for ≈65% of all acute ischemic cerebrovascular events13 and lead to a risk of 10% to 15% stroke occurrence within 90 days 14, 15. Factors associated with a high risk of recurrence in patients with TIA or minor stroke were different from those of general stroke16; however, data from previous studies were derived from trials or cohorts in which patients were recruited weeks or months after their initial event and underestimated early recurrence, especially for minor stroke or TIA 8, 9, 17.…”