Urgent preventive treatment can reduce risk of early recurrent strokes

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Early initiation of existing treatments after transient ischemic attack (TIA) or minor stroke is associated with at least 80 percent reduction in the risk of early recurrent stroke, according to study results published in the Oct. 20 issue of The Lancet.

The researchers affiliated with stroke prevention research unit, department of clinical neurology at the Radcliffe Infirmary in Oxford, United Kingdom, examined modeling studies, which suggested that urgent use of preventive treatments could reduce the risk by 80 to 90 percent. The researchers’ aim was to determine the effect of more rapid treatment after TIA and minor stroke in patients who are not directly admitted to the hospital. Most healthcare systems make small provisions due to the absence of evidence.

The researchers did a prospective (phase 1: April 1, 2002 to Sept. 30, 2004) versus after (phase 2: Oct. 1, 2004 to March 31, 2007) study of the effect on process of care and outcome of more urgent and immediate treatment in clinics, rather than subsequent initiation in primary care in patients with TIA or minor stroke not directly admitted to the hospital.

The primary outcome was the risk of stroke within 90 days of first seeking medical attention, with independent blinded audit of all events.

Of the 1,278 patients who had TIA or stroke (634 in phase 1 and 644 in phase 2), 607 were directly referred or presented to the hospital, 620 were referred for outpatient assessment and 51 were not referred to secondary care. Of all outpatient referrals, 95 percent (591) were referred to the study clinic.

The median delay to assessment in the study clinic fell from 3 days in phase 1 to less than 1 day in phase 2, and median delay to first prescription of treatment fell from 20 days to 1 day. The 90-day risk of recurrent stroke in the patients referred to the study clinic was 10.3 percent (32/310 patients) in phase 1 and 21 percent (6/281 patients) in phase 2; there was no significant change in risk in patients treated elsewhere.

The researchers concluded by suggesting that further follow-up is required to determine long-term outcome, but the results have immediate implications for service provision and public education about TIA and minor stroke.