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Early Risk of Stroke After First-Ever Transient Ischemic Attack Might be Higher than Believed: Presented at ESC

By Bruce Sylvester
Special to DG News

GENEVA, SWITZERLAND -- June 3, 2002 -- The early risk of having a stroke after a transient ischemic attack (TIA) is higher than suggested by previous research, investigators reported here Friday at the European Stroke Conference.

Previous studies suggested an early risk of stroke after a first-ever TIA of 2 percent at seven days and 4 percent at four weeks. These figures, however, may underestimate the true risk because of delays before stroke subjects entered the studies and the exclusion of strokes during this time, according to J.K. Lovett, MD, lead investigator for the Stroke Prevention Research Unit of the Department of Clinical Neurology, Radcliffe Infirmary, Oxford, United Kingdom.

"The early risk of stroke after a TIA is therefore unknown, and guidelines vary on how urgently patients should be investigated," the researchers wrote in describing their reason for undertaking their study, which used data from the Oxfordshire Community Stroke Project to estimate the early risk of stroke after a TIA.

They made two analyses of data from the Oxfordshire Project. In analysis 1, they evaluated the records of 179 patients whose notification event was a TIA and whose median length of notification was six days. In analysis 2, they evaluated the records of 209 patients who had definitely experienced a first-ever TIA within the period of the study.

They found that the seven-day stroke risk after a first-ever TIA was 1.7 percent (95 percent confidence interval 0-3.6 percent) in analysis 1 and 8.6 percent (4.8-12.4 percent) in analysis 2. The 30-day risks were 3.4 percent (0.7-6.0 percent) and 12.0 percent (7.6-16.4 percent) respectively.

In analysis 2, the investigators saw a rise in risk of ensuing stroke to 12.1 percent (5.4-18.8 percent) at seven days and 18.8 percent (10.7-26.9 percent) at 30 days in patients with hypertension who had experienced cerebral rather than ocular TIAs.

As in previous studies, the researchers found that analysis 1 underestimates the real early risk of an ensuing stroke due to a delay between the first TIA and notification (median six days), and the exclusion of 30 patients who were notified as a stroke but who had a previous eligible TIA during the study period. Analysis 2 may overestimate the risk because it excluded some TIA patients without stroke who did not present for medical attention, according to the researchers.

Based on their findings, the authors urged that public education about the symptoms of a TIA, immediate medical attention for a suspected TIA, and the use of stroke prevention strategies receive more attention among physicians and the general public.

J.K. Lovett, MD, lead investigator, reported the findings in Geneva on behalf of the research team at the Stroke Prevention Research Unit of the Department of Clinical Neurology, Radcliffe Infirmary, Oxford, United Kingdom.

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